There is an increasing awareness of the link between diabetes, both type 1 and type 2, and depression. But which one leads to the other or affects its course and outcome has not yet been fully elucidated. Nevertheless, it has been estimated that people with diabetes are twice as likely as the general population to suffer from depression, with the risk being higher in women than in men 1 2 . Depending on the definition used the prevalence of depression among people with diabetes ranges from 8.5 to 32.5% 3 4 5 .People with poorly controlled diabetes are more likely to have depression 5 . This may be because depression leads to problems with adherence to medication and diet, and affects quality of life 6 7 . Depression also seems to be a factor in increasing the risk of developing diabetes-related complications 8 , and also increased mortality 9 . Having diabetes and depression may also be associated with higher risk of suicide, with some reports of a 10-fold increased risk of suicide and suicidal ideation 10 11 . Thus the combination of diabetes and depression appears to be associated with a poorer quality of life, and with increased morbidity and mortality.
Type 2 diabetes and schizophrenia
There have been numerous reports of diabetes occurring among people with psychotic disorders. However, these studies, many of which have been retrospective and of variable size, have not always been controlled for potential confounders such as age, race, gender, family history and obesity. In addition, many studies have not been controlled for use of antipsychotic drugs, which themselves, especially some of the newer, atypical agents, have been implicated in the development of diabetes.
Furthermore, it has been suggested that the apparent difference in risk between medications may partly be attributed to a greater degree of vigilance with more glucose monitoring being done among those taking atypical antipsychotics such as clozapine or olanzapine, as opposed to older drugs such as risperidone 12 . Other shortfalls include differences in whether subjects were screened before or after initiating medication and the type of test(s) used for diagnosing diabetes 13 .
As an illustration of the link between schizophrenia and diabetes, a study from the USA 14 reported a diabetes prevalence of 15% among those with schizophrenia, compared to 3% from the general population. Increasing age and African American background were highlighted as being important risk factors. Notably, much of this study predated the widespread use of atypical antipsychotics.
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12.Citrome,L. Jaffe,A. Levine,J. Allingham,B. Robinson,J. Relationship between antipsychotic medication treatment and new cases of diabetes among psychiatric inpatients. Psychiatr Serv.2004; 55(9): 1006-1013
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14.Dixon,L. Weiden,P. Delahanty,J. Goldberg,R. Postrado,L. Lucksted,A. Lehman,A. Prevalence and correlates of diabetes in national schizophrenia samples. Schizophr Bull.2000; 26(4): 903-912
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