Condition May Have Profound Effects on Mental Health

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New research shows that type 2 diabetes can also have profound effects on mental health, especially for those diagnosed earlier in life. Fertnig/Getty Images
  • Millions of people visit hospitals with diabetes-related complications each year.
  • New research has found that mental health disorders account for a notable proportion of hospital admissions.
  • Those diagnosed with type 2 diabetes in earlier adulthood are more likely to be affected by mental health concerns.
  • More research is needed into how early diagnosis impacts mental well-being.

Around 17 million diabetes-related visits are made to the emergency department each year for concerns such as hypoglycemia and cardiovascular issues.

However, a new study published August 4 in PLOS Medicine has revealed another significant driver behind hospital admissions: mental health.

Notably, those diagnosed with type 2 diabetes before age 40 — particularly women — were more likely to be admitted for mental health treatment.

Researchers stated the findings highlight the importance of introducing mental health care into diabetes treatment plans.

To better gauge the effects of type 2 diabetes on the body and brain, a team of researchers in Hong Kong compared the length and causes of hospital stays among those with and without metabolic disease.

Using data from the Hong Kong Hospital Authority, they assessed 1,516,508 individuals, exactly half of whom had type 2 diabetes and half did not.

Data from these individuals were “matched” one-to-one according to age, sex, and index year (when they were admitted).

Researchers collected information concerning hospital admissions between 2002 and 2018 and followed up with participants for a median of 7.8 years until 2019.

During this time, those with type 2 diabetes spent more days in the hospital. People diagnosed at an older age were more likely to be admitted due to circulatory and respiratory conditions.

However, among those diagnosed with diabetes before age 40, a significant 38.4% of hospital “bed days” were due to mental health disorders. A higher number of women were admitted for mental health concerns than men.

Some of the more common mental health disorders that those with type 2 diabetes entered the hospital for included schizophrenia, bipolar disorder, and depression.

In their paper, the researchers stated: “The substantial burden of hospital bed-days caused by mental health disorders in young people with type 2 diabetes calls for healthcare systems to allocate adequate resources and develop targeted strategies to meet their mental health needs.”

Previous studies have highlighted the significant association between type 2 diabetes and mental health disorders.

It’s important to note “that the relationship between diabetes and poor mental health is bi-directional,” stated Briana Mezuk, a professor in the Department of Epidemiology at the University of Michigan School of Public Health.

For instance, those with diabetes are two to three times more likely to experience depression.

“Diabetes and depression share common mechanisms,” said Dr. Absalon Gutierrez, an endocrinologist with UTHealth Houston. These mechanisms include the overactivation of the nervous system and dysregulation of the main stress response system in the body called “the hypothalamic-pituitary-adrenal axis”

These factors, he told Healthline, “Can lead to higher cortisol and catecholamine levels [types of hormones], which can make both diseases worse.”

Meanwhile, around 40% of diabetes patients encounter anxiety, and people with schizophrenia have a two to five times greater likelihood of developing type 2 diabetes compared to the general population.

Numerous elements potentially contribute to this two-way relationship.

The latest study found that younger and female individuals with diabetes were more likely to be hospitalized for mental health reasons.

As to why these factors are important, “There are many potential underlying mechanisms, but more research is needed,” said Aaron Breedlove, Ph.D., a psychologist in the Department of Psychiatry and Behavioral Health at The Ohio State University Wexner Medical Center and College of Medicine.

While the majority of type 2 diabetes diagnoses occur in those aged 45 and above, the opposite is true for mental health. This may help explain why researchers in the new study saw a large number of younger individuals with diabetes hospitalized for mental health disorders.

“Generally, most serious mental illness has an earlier age of onset,” explained Stephanie Freitag, Ph.D., a licensed psychologist in New York. “According to the American Psychological Association, 50% of mental illness begins by 14 and 74% by 24.”

As for the gender difference, Freitag noted this is also unsurprising. “Women are more likely to experience depression, anxiety, and traumatic stress disorder than men,” she told Healthline.

According to the National Institute of Mental Health, there’s a greater prevalence of serious mental illness among women,” Freitag said. “[As] young adults have the highest prevalence, young women are most susceptible.”

There are various physiological health discrepancies between men and women, some of which may influence diabetes. According to Breedlove, these include differences in hormones, insulin sensitivity, and risk profiles for concerns such as cardiovascular disease.

Finally, said Gutierrez, it’s important to note that “women are less likely to receive optimal care than men.”

Diagnosis of a chronic condition at any age is challenging enough, and ongoing stress and anxiety can quickly evolve into mental health disorders.

Diabetes “requires individuals to engage in a host of complex behaviors on a daily basis,” Mezuk told Healthline.

“This may contribute to why people with earlier-onset type 2 diabetes are more likely to develop mental health concerns: they have simply been working to self-manage this condition for longer,” she said.

From remembering to take medications and check blood sugar to closely monitoring diet and exercise levels, “the strain of this self-management — especially when some aspects of diabetes are not fully within a person’s control — can negatively impact mental health,” Mezuk added.

Breedlove said it’s essential to consider the lifestyle adjustments those in earlier adulthood face and how a medical diagnosis could further complicate things.

“Adjusting to a chronic medical condition at a critical developmental stage (even in the 20’s) could be more psychologically stressful than [for] older individuals who have a clearer sense of who they are and have greater perspective and problem-solving skills,” Breedlove said.

Furthermore, younger adults are often more aware of their peers’ opinions — and “There are social reasons why having diabetes can impair mental health,” added Mezuk. “Such as feeling stigmatized, monitored, or judged by others.”

Stress could also negatively impact diabetes outcomes, as the stress hormone cortisol may be linked to decreased insulin sensitivity.

High levels of inflammation in the body are associated with health concerns ranging from cardiovascular disease to arthritis. However, it’s also believed to be a key player in both diabetes and some mental health disorders — “which suggests a potential shared pathway,” stated Breedlove.

Inflammation’s impacts on the central nervous system are thought to contribute to depression, while inflammation in the brain is linked to anxiety.

Conversely, “Depression and other mental disorders are associated with immune dysfunction, which can set off inflammation,” Gutierrez said.

He added: “[This] can impair the binding of insulin to its receptors, [which] leads to higher blood glucose, insulin resistance, and possible diabetes.”

While insulin is perhaps best known for its effect on blood glucose, Breedlove revealed it also plays a key role in regulating neurotransmitters in the brain.

“Neurotransmitters like serotonin and dopamine impact mood regulation,” he said. “Insulin resistance may disrupt these levels, leading to changes in mood and emotional well-being.”

Medications are a vital component in managing both diabetes and mental health symptoms.

However, “Many antipsychotic medications can lead to weight gain and metabolic problems, which lead to the risk of developing insulin resistance,” said Breedlove.

On the other hand, “medications to manage type 2 diabetes or exogenous insulin can lead to low blood sugars,” he stated.

This, in turn, can lead to symptoms that may impact mental well-being — such as “rapid heartbeat, shaking, sweating, anxiety, and confusion, amongst others,” Breedlove noted.

As highlighted, it’s vital for those with type 2 diabetes to take steps to aid their mental well-being. Freitag recommended the following:

  • Engage in good “daily hygiene,” such as regular exercise, grooming, adequate sleep, and eating a healthy diet.
  • Consider working with a nutritionist, trainer, or other specialists to help keep these habits in check.
  • Work with practitioners well-versed in mental and physical health conditions and their comorbidity. This will allow for informed conversations about medications and other factors that may escalate the onset of mental illness.
  • Reduce stressors where possible.
  • Create structured daily rhythms and routines for work and social life.
  • If you feel your mental health has taken a hit, don’t be afraid to seek professional help.