Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694840003908.pdf (Malta)
Diabetes and Mental Illness Parliamentary Group on Diabetes 3rd June 2014 Dolores Gauci Co-morbidity  Greatest challenge facing medicine is co-morbidity  Two thirds of all people over 55 years of age with a chronic disorder such as diabetes and Depression, have more than one illness at the same time (WHO 2011)  Co-morbidity of mental and physical illness is much less appreciated despite co-occurring commonly with grave consequences(Lawrence & Coghlan, 2002)  Prevalence of diabetes is increasing in both the general and psychiatric populations (Katon et al 2009)  Health and Economic burden of diabetes falls disproportionately on persons with mental illness particularly depression and anxiety (Atlantis et al 2012) Diabetes and Schizophrenia  People with schizophrenia  have multiple risk factors for type 2 diabetes  may represent an independent high-risk group for diabetes  Interaction between Schizophrenia, antipsychotic medication and diabetes is complex  Schizophrenia itself may be an additional risk factor for diabetes as may antipsychotic treatment (metabolic disorders) de Hert, M ., 2012 Co-morbidity in Children & Young People  Diabetes has a negative impact on virtually all aspects of child development increaseing the risk for psychiatric disorder, anxiety and depression being the most common.
 Females with type 1 diabetes are twice as much at risk of developing anorexia or bulimia.

 40% of 15-30 year olds regularly omit insulin intake with possible devastating consequences  Emerging dual diagnosis of type 1 diabetes and eating disorder.
 Syndrome termed “ED-DMT1”; affecting teenage girls  Describes the intentional misuse of insulin for weight control  Devastating effects leading to mortality  There is still a large unmet need to quantify and qualify the co-morbidity of these disorders in children and young people.
Diabetes and Depression: Facts  Type 2 diabetes and depression  are common chronic illnesses (Katon, 1992; American Diabetes Association, 2012)  individually can be among the most disabling chronic disorders and when they occur comorbidly, they are even more detrimental  31-33% of persons with diabetes suffer from depression (Anderson & Freedland, 2000; Van Der Feltz C M, 2011)  In the presence of diabetes, the prevalence of depression increases to 15% to 30% depending on depression definition, population sample and study type (Stone et al .
2006; Anderson et al 2001)  Persons with depressive disorders are twice as likely as the rest of the population to also suffer from diabetes (Bjorntorp, 2001) Bi-directional relationship  Diabetes and Depression exhibit a bi-directional relationship, with each disease an independent risk factor for development of the other  Prognosis of both diabetes and depression is worse for either disease when they are co- morbid than it is when they occur separately (Lustman et al., 2000; Egede,2006)  Bi-directional relationship is not limited to its effects on prevalence.
When these diseases are co-morbid, they significantly amplify the cost, morbidity and mortality expected from either one alone  In the case of depression, changes in blood sugar levels have been linked directly to moods such as anger, anxiety, sadness, frustration and general wellbeing (Gonder-Frederick et al., 1989) Bi-directional relationship  More than 70% of patents with diabetes have depressive episodes lasting longer than 2 years (Katon, et.
al 2004)  Dysthymia and double depression is more common in patients with diabetes (Katon, et al 2004)  MDD is highly recurrent in diabetic patients – 80% of depressed persons with diabetes experience a relapse of symptoms with an average relapse rate of nearly 1 episode every year (Lustman et al, 1997)  Depression is one of the most disabling chronic conditions.
The functional impairment it causes is substantially worse when it occurs in the context of diabetes  Depression in diabetes has been associated with decreased self-care, including decreased adherence to treatment, exercise, smoking cessation and eating a healthy diet (Ciechanowski et al, 2000) Bi-directional relationship & other risk factors  Depression  contributes to the pathophysiology of diabetes (Katon et al 2004)  is associated to many other adverse outcomes (de Groot et al, 2001)  in diabetic patients is a risk factor for dementia, hospitalisation and even death  In the case of dementia, diabetes and depression are independent risk factors for vascular and Alzheimer-type dementias, and co-morbidly they impart substantially more risk than either one alone Increased costs of diabetes care  Depression contributes to decreased quality of life and increased costs of diabetes care  Costs of the care for depressed versus non-depressed patients with diabetes was 4.5 – fold higher  Costs for severely depressed patients were 86% higher than those for patients with less severe depressive symptoms (Ciechanowski et al, 2000; Egede et al, 2002)  The economic impact is particular high in the area of employment because of absenteeism, presenteeism and withdrawal from the labour market , as well as in the area of social welfare due to benefits (McDaid, D. 2012) Conclusions  Prevalence of diabetes and mental illness is increasing  Association between type 2 diabetes and mental illness is bi-directional  The prevalence of diabetes has been found to be consistently higher for people with mental illness  There is limited awareness and knowledge of the  frequency and consequences of co-morbidity of diabetes and mental illness  developmental and psychological impact of diabetes on children and young people  Resources directed towards improving care and quality of life for persons with co-morbid diabetes and depression are insufficient Recommendations  Multi-condition Collaborative Care Programme  Routine screening of patients with diabetes for psychopathology and vice verse, as well as lifestyle risk factors, to inform practice for more effective management and prevention planning.
(e.g PHQ-9)  Public Health Interventions  Effective Treatment psychological – pharmacological and  Training of Health Care Professionals (GPs, Nurses and Specialists (Endocrinologists and Psychiatrists)  Research  Co-morbidity its effects on development and mental health) in children and young people (diabetes and  Epidemiological studies on co-morbidity of diabetes and depression  Treatment effectiveness Acknowledgements  Profs Norman Sartorius and Mr Larry Cimino and the Dialogue on Diabetes and Depression Platform  Profs Alan M. Jacobson, M.D.
Chief Research Officer, and Director of the Diabetes, Obesity and Cardiometabolic Research Centre, Winthrop- University Hospital Mineola, NY  Profs.

Bennett L. Leventhal, MD, Department of Child and Adolescent Psychiatry, NY University Langone Medical Center and the NYU Child Study Center.

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