In a special issue of the journal Current Diabetes Reviews, an article addresses the link between diabetes and depression as a likely cause for the increased self-harm rates seen in those with both type I and type II diabetes.
The authors, Professor Madhuker Trivedi from the University of Texas Southwestern Medical Center and endocrinologist Dr. Alyson Myers of Northwell Health in New York, discuss the importance of managing diabetes medications in self-harming or suicidal diabetic patients.
They suggest that individuals with diabetes be screened for both depression and suicidality, as rates of both may be higher than in the general population. They also address the management goals of such patients and the need for further research in this area.
The review is a follow-up to a study the authors published in 2013 in which they found that 9.7 percent of patients with newly diagnosed diabetes (less than 24 months) had a history of suicide attempts. Half of those patients tested positive for depression at the time of the study.
Insulin is considered a high risk medication, because it can be manipulated to cause severe hyper- or hypoglycemia, both of which can lead to death. Oral agents such as sulfonylureas or metformin have also been used in overdoses with or without insulin.
Persons with both type I and type II diabetes have been known to have higher rates of depressive disorders; as a result suicidal ideation should be assessed in such patients. In addition, death by insulin may be misclassified as an accident, when it was in fact a suicide attempt. The manner in which to distinguish between the two, as well as how to manage these high-risk patients is described in this article.
The authors also discuss cases involving overdose by continuous subcutaneous insulin infusion, also known as insulin pump therapy. The acuity of medical therapy in such overdoses is significant as some of the agents used can have hypoglycemic effects for up to 72 hours.
Frequent glycemic monitoring and a multi-disciplinary approach to patient care with a behavioral health and medical team is needed.
The article comes in light of a recent statement released by the American Diabetes Association (ADA) in regards to the importance of assessing the psychosocial issues that impact individuals with diabetes, such as co-morbid mood disorders, food insecurities or lack of social support.
Diabetes affects roughly 30 million Americans, and is one of the leading causes of disability and mortality. As a result, organizations such as the ADA, Endocrine Society and American Association of Clinical Endocrinologists (AACE) have made efforts to move away from the one size fits all management of diabetes.
Instead, diabetes management is now customized based on patient variables such as age, life expectancy, co-morbid conditions, finances, and patient goals.
Source: Bentham Science Publishers