Psychiatric morbidity and quality of life among adults with Type I and Type II diabetes mellitus

Abstract

Summary D iabetes mellitus is a metabolic disorder of multiple etiologies characterized by the presence of hyperglycemia with disturbance of carbohydrate, fat and protein metabolism. Most common types of DM are: Type I DM which is caused by a lack of insulin due to the destruction of insulin-producing beta cells in the pancreas. Type II DM which is the most common form of diabetes caused by insulin resistance, a condi¬tion in which the body’s muscle, fat, and liver cells do not use insulin effectively. Diabetes mellitus is a serious condition with potentially devastating complications that affects all age groups worldwide. In 2012, the International Diabetes Federation (IDF) estimated that 371 million people had diabetes. This number is projected to rise to 552 million (or 1 in 10 adults) by 2030, which equals to 3 new cases per second. During the last years, the co-morbidity of mental disorders with chronic health conditions has emerged as a topic of considerable clinical and policy interest. Diabetes is considered one of the most psychologically demanding of the chronic medical illnesses because it requires strict daily management of the treatment by the patients themselves. Diabetes mellitus as well as psychiatric disorders are common. These may occur with one another and/or one may worsen the other. Psychiatric disorders are at least twice as common in patients with diabetes compared to the general population. However, many of them are under recognized and under treated. People with mental disorders have several risk factors that are likely to influence diabetes outcomes. According to evidences, the association between these conditions is bi-directional. The presence of psychiatric co-morbidity can result in difficult clinical courses, depression negatively affects quality of life, treatment outcome and medication adherence of patients with DM. On the other hand, poor diabetes control might cause or exacerbate depression via direct effects on brain functions or indirectly through complications, functional impairment, or decreased quality of life. The incidence of depression in persons with diabetes seems to be associated with female gender, low socio-economic status, fam¬ily history, obesity, smoking habits, physical activity and sedentary life. Among the many additional complications which coincide with DM anxiety, tension, dysthymia and stress are most commonly under-detected. This is despite the fact that a growing body of literature has reported that patients with diabetes are almost twice as likely to suffer from these psychiatric disorders as the general population. Also, such symptoms were associated with poor glycaemic control, diabetes complications, worsened prognosis and quality of life. Quality of life itself is a subjective construct which varies with the population studied. It is generally conceptualized as a multi-dimensional construct made up of a number of independent domains including physical health, psychological well-being, social relationships, functional roles and subjective sense of life satisfaction.