The Canadian Diabetes Association released its 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada (the Guidelines) that aim to improve prevention strategies and the quality of care for those living with the disease. There are specific guidelines pertaining to mental health and diabetes. Key messages from the Guidelines are excerpted below:
- Psychiatric disorders, in particular major depressive disorder (MDD), generalized anxiety disorder and eating disorders, are more prevalent in people with diabetes compared to the general population.
- People diagnosed with serious mental illnesses, such as MDD, bipolar disorder and schizophrenia, have a higher risk of developing diabetes than the general population.
- All individuals with diabetes should be regularly screened for the presence of depressive and anxious symptoms.
- Compared to those with diabetes only, individuals with diabetes and mental health disorders have decreased medication adherence, decreased compliance with diabetes self-care, increased functional impairment, increased risk of complications associated with diabetes, increased healthcare costs and an increased risk of early mortality.
- Treatment modalities should be incorporated into primary care and self-management education interventions to facilitate adaptation to diabetes, reduce diabetes-related distress and improve outcomes including: motivational interventions, stress management strategies, coping skills training, family therapy and collaborative case management.
- Individuals taking psychiatric medications, particularly atypical antipsychotics, benefit from regular screening of metabolic parameters.
Recommendations from the Guidelines include:
- Individuals with diabetes should be regularly screened for subclinical psychological distress and psychiatric disorders (e.g. depressive and anxiety disorders) by interview or with a standardized questionnaire.
- Psychosocial interventions should be integrated into diabetes care plans (e.g. motivational interventions, stress management strategies, coping skills training, family therapy and case management.
- Antidepressant medication should be used to treat acute depression and for maintenance treatment to prevent recurrence of depression.
- Antipsychotic medications (especially atypical/second generation) can cause adverse metabolic changes therefore regular metabolic monitoring is recommended for patients with and without diabetes who are treated with such medications.