For many patients, the management of diabetes mellitus can be a complex and often overwhelming task. This is because it involves many different components: planning meals, engaging in regular exercise, blood glucose monitoring, taking medication on time (often coordinating them with a busy life, variable schedules, and, work or home commitments), taking time out for laboratory testing and, frequent doctor visits. Incorporating all these elements into daily life can be a challenge and may lead to frustration and distress, leading to the development of a psychosocial disorder known as ‘Diabetes distress’. Diabetes distress (DD) may be present in up to 45% of people with diabetes.
It is essential to understand that DD is not a psychiatric disorder but rather, a broad affective reaction to the stress of living with this chronic and complex disease. Patients with DD experience feelings such as stress, guilt, denial or anger that are directed at or related directly to living with diabetes and the burden of self-management of diabetes. DD should not be confused with depression, which may occur in a subset of patients who have DD, and unlike DD often requires medications for depression such as SSRI medicines. On the other hand, most patients with diabetes who are depressed have underlying DD.
Depression is a more generalized feeling of sorrow, hopelessness, lack of motivation, self-guilt, and anhedonia (inability to feel happy or have pleasure in various aspects of life – not just diabetes). Depression is associated with certain well-defined physical symptoms, such as insomnia, increased or decreased appetite, weight gain or weight loss, and recurring thoughts of suicide. Depending on the number of these symptoms present in a patient, depression is divided into major or minor depression. The table below outlines how a patient is classified as having major or minor depression.
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