Patients with diabetes are at a higher risk of developing mental illness than the general population because of many factors. SCARF, a city-based NGO, is organising a lecture on the link between diabetes and mental illness and the scope for integrated treatment today
CHENNAI: Mental illnesses can take a huge toll on the body and can in fact cause or increase the risk of developing other physical illnesses, such as cardiovascular disease, tuberculosis, diabetes etc. To create awareness about the relationship between physical and mental disorders, Schizophrenia Research Foundation (SCARF), an NGO in Chennai, is organising a series of lectures, and the first session will focus on the link between diabetes and mental illness. CE chats with Dr Shruti Sivaprakash, endocrinologist and Dr Padmavati, additional director, SCARF, to know more about how these illnesses are linked, whether they can be prevented and/or treated, and the need for an integrated treatment system of both conditions.
Patients with diabetes are at higher risk of mental health disorders — including depression and psychotic disorders — than the general population. Likewise, patients with mental health disorders are at higher risk of developing diabetes, due to the medications and lack of physical exercise. However, patients with such co-morbidity are frequently misdiagnosed and undertreated, increasing the risk of long-term complications from either type of disorder. “The incidence of Type II diabetes is alarmingly high in India. According to statistics, two out of five people do not know they have diabetes, because they have not checked it,” Dr Shruti Sivaprakash explains, adding that the rising numbers is mainly due to the changing lifestyle.
There are mental-health implications to people with diabetes, especially on the early onset. “Diabetes patients are prone to depression, dementia or cognitive decline, which leads to memory impairment and the inability to perform daily activities. Sometimes, especially among the elderly population, you can’t differentiate between memory impairment and depression. That’s why we need a good psychiatrist to assess the symptoms early on — to see the impact of diabetes on the mentally ill,” she points out.
For many patients, it’s a shock when they are diagnosed with diabetes, and many go into denial. “A lot of women become depressed just by hearing they’re diabetic. That makes it worse because they don’t put in the much-needed efforts to exercise and eat right. They also become tired often and don’t sleep well.
All this indirectly affects their sugar levels and makes it worse,” rues Dr Shruti.
That’s why it’s crucial to make people aware of the link between diabetes and mental illness. “As physicians, we need to do a thorough evaluation of the patients to understand how they’re feeling mentally. We need to pick up on subtle signs of depression, especially among diabetics,” she says, and advises patients to seek timely help if they’re not feeling motivated. “Only when we treat depression, diabetes will begin to improve. Even if we put them on multiple medications and insulin, it will not improve their sugar levels.” she explains.
Likewise, people with mental illness are prone to developing diabetes, and other chronic cardio-vascular diseases. “The milder mental illnesses, like anxiety and depression, can impact lifestyle; some people will eat a lot, and others will not exercise. These people might develop impaired glucose tolerance, or even diabetes,” says Dr Padmavati. “The reasons why diabetes occurs in people with severe mental illnesses, like schizophrenia, mood disorders, bipolar disorders, are not clear. Compared to the general population, people with mental illness, particularly schizophrenia, will have less physical exercise and high basic metabolism — and are more likely to develop diabetes.”
Psychiatric medications can also precipitate diabetes in people who already have increased risk of diabetes. “The psycho-pharmacological agents might cause diabetes or glucose intolerance by various mechanisms — there is potential to increase the adipose tissue (fat tissue) in the body, which can contribute to impaired glucose metabolism,” she explains. There is an increased mortality rate among persons with serious mental illness, which is primarily attributed to physical diseases like diabetes or cardiovascular illnesses. “This is a huge problem.
We need to start addressing these problems in the initial treatments of schizophrenia or mood disorders, and depressive disorders. We should start encouraging people to do more exercise and maintain good diet,” she advises.
Dr Padmavati has been doing surveys among people with serious mental illness in South India, and one of the things she found is that there is no coordinated treatment of diabetes and psychiatric problems. “As a psychiatrist, we should switch diabetics to medications that do not raise blood sugar levels. This kind of integrated management is crucial, which is why the lecture series is important,” she says.
The talk on ‘Body and Mind in Diabetes — What we need to know' will be held today at SCARF Resource and Training centre, Greams Road, from 4 pm onwards.
For details, call: 26153971