The interface of depression and diabetes: treatment considerations

Abstract

This state-of-the-art review explores the relationship between depression and diabetes, highlighting the two-way influences that make treatment challenging and worsen the outcomes of both conditions. Depression and diabetes often co-occur and share genetic, lifestyle, and psychosocial risk factors. Lifestyle elements such as diet, physical activity, and sleep patterns play a role on the development and management of both conditions, highlighting the need for integrated treatment strategies. The evidence suggests that traditional management strategies focusing on either condition in isolation fall short of addressing the intertwined nature of diabetes and depression. Instead, integrated care models encompassing psychological support and medical management are recommended to improve treatment efficacy and patient adherence. Such models require collaboration across multiple healthcare disciplines, including endocrinology, psychiatry, and primary care, to offer a holistic approach to patient care. This review also identifies significant patient-related barriers to effective management, such as stigma, psychological resistance, and health literacy, which need to be addressed through patient-centered education and support systems. Future directions for research include longitudinal studies in diverse populations to further elucidate causal relationships and the exploration of novel therapeutic targets, as well as the effectiveness of healthcare models aimed at preventing the onset of one condition in individuals diagnosed with the other.

Fig. 1. Treatment considerations for co-morbid depression and depression.

GLP1-RAs Glucagon-like Peptide-1 Receptor Agonists, HPA Hypothalamic-Pituitary-Adrenal, SGLT2Is Sodium-Glucose Cotransporter-2 Inhibitors, SNRIs Serotonin and Norepinephrine Reuptake Inhibitors, SSRIs Selective Serotonin Reuptake Inhibitors, T2DM Type 2 Diabetes Mellitus. The symbols ↑, ↓, and ↔ indicate an increase, decrease or no impact/effect, respectively. The figure was created with BioRender (www.biorender.com).