Understanding the mental aspect can help fight diabetes
The 2012 listing for diabetes rates by country, published by the International Diabetes Association, reads like a Who's Who of Arabian Gulf states.
Kuwait, Saudi Arabia, Qatar, and Bahrain all make the top ten, with prevalence rates of 23.9, 23.4, 23.3, and 22.4 per cent respectively. The UAE did not rank in the top ten this year, but the reported rate, 18.2 per cent, is still disconcertingly high.
Much has been written about the complications associated with diabetes, but the psychological consequences are often overlooked or even ignored. As a result the psychological aspect of care provision is sadly lacking in most Gulf nations.
One psychological disorder commonly associated with diabetes is anxiety. Diabetes UK, the leading diabetes charity there, says diabetics are 20 per cent more likely to experience an anxiety disorder than people without the disease.
This springs largely from worry about experiencing hypoglycaemia-related complications while working or even, God forbid, while driving. Similarly, a seizure or loss of consciousness as a result of hypoglycaemia can lead to post-traumatic stress disorder, which can get worse if you don't intervene early.
Anxiety and depression commonly coincide. The Canadian Diabetes Association says 15 per cent of diabetics also experience a major depressive disorder. That's almost double the rate in the general population. Being told you have a life-altering, potentially fatal illness would, after all, upset most people. And having to cope with daily self-care can drive people to despair.
However, a number of studies suggest that depression occurs before the onset of diabetes. The life-changing events associated with diabetes may give rise to a depressive episode, but on the other hand being depressed often leads to reduced physical activity and weight gain - both factors that could contribute to the onset of diabetes.
Whichever comes first, depression or diabetes, the relationship is not a good one. Repeatedly research has shown that depressed diabetics have poorer clinical outcomes, in rates of both amputation and mortality.
The bottom line is that depression greatly exacerbates diabetes, and treating the depression would improve the clinical management of diabetes. This is well-documented, and yet physical health and psychological health specialists often don't talk, and may not even inhabit the same health care facility.
Eating disorders are another psychological problem associated with diabetes. Anorexia and bulimia are most common among young women and teenage girls. And women with type 1 diabetes are, says the American Diabetes Association, at increased risk of developing eating disorders. Type 1 diabetics are required to take insulin because their body cannot produce enough of it; but insulin therapy can result in weight gain. Consequently, in our body-image-obsessed societies, some women develop eating disorders after a medically induced weight gain. Others just cut down on the meds: the ADA says as many as 40 per cent of young women refuse to take insulin injections as prescribed, for fear of weight gain.
A 2008 study published in the journal Psychiatry reported the prevalence of anorexia nervosa in a population of diabetic females as 0.27 per cent, compared to 0.06 per cent of a comparable non-diabetic control group. The same pattern was found for bulimia nervosa: 1.73 per cent and 0.69 per cent, respectively.
Considering the high prevalence of diabetes in the Gulf region we should aim for the highest quality of treatment and prevention.
The well-documented psychological problems associated with the illness, suggest that the best care and prevention has to include a psychological and psychotherapeutic aspect. More should be done to offer holistic treatment, including talk-based psychotherapies, particularly in cases involving depression.
That should go hand in hand with campaigns that aim to remove the stigma associated with psychological interventions. Findings that suggest depression precedes diabetes suggest we might benefit from preventive initiatives aimed at promoting psychological health, making it less likely people will develop depression in the first place.
Diabetes is one of the region's greatest health challenges. Psychology and psychological therapies can be very useful in helping to manage this serious problem.
Mariam Al Romaithi studies psychology at Zayed University
Updated: February 19, 2013 04:00 AM