From the Guidelines
The first-line treatment for anxiety in diabetic patients should involve a combination of selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT), with a strong emphasis on screening for anxiety symptoms and referral to a qualified behavioral health professional if necessary, as recommended by the most recent guidelines 1.
Key Considerations
- Anxiety symptoms are common in people with diabetes, with a lifetime prevalence of generalized anxiety disorder estimated to be 19.5% in people with either type 1 or type 2 diabetes 1.
- The treatment plan should include SSRIs, such as sertraline or escitalopram, which have minimal effects on blood glucose levels and fewer drug interactions compared to other anxiolytics.
- CBT is strongly recommended, typically involving 8-12 weekly sessions, to provide coping strategies and address the neurochemical imbalance.
- Lifestyle modifications, including regular physical activity, stress management techniques, and proper sleep hygiene, should also be incorporated into the treatment plan to manage anxiety symptoms and potentially improve diabetes management.
Screening and Referral
- Healthcare professionals should screen people with diabetes for anxiety symptoms and consider referral to a qualified behavioral health professional for further assessment and treatment if anxiety symptoms indicate interference with diabetes self-management behaviors or quality of life 1.
- Screening for hypoglycemia or fear of hypoglycemia is also recommended, especially in individuals who have experienced severe and/or frequent hypoglycemic events.
Monitoring and Follow-up
- Blood glucose levels should be monitored more frequently when starting anxiety medication, as both anxiety itself and some medications can affect glycemic control.
- Treatment should continue for at least 6-12 months after symptom resolution to prevent relapse.
From the Research
First Line Treatment for Anxiety in Diabetic Patients
- The first line treatment for anxiety in diabetic patients is not explicitly stated in the provided studies, but based on the available evidence, selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat anxiety disorders 2, 3, 4.
- SSRIs, such as fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram, have been shown to be effective in treating anxiety disorders, including panic disorder and agoraphobia 3, 4.
- A 3-level network meta-analysis found that all SSRIs and serotonin and norepinephrine reuptake inhibitors (SNRIs) were effective for multiple symptom domains, and in patients from all included diagnostic categories, with minimal differences between medications concerning efficacy and acceptability 2.
- The optimal dose of SSRIs for treating depression, which is often comorbid with anxiety, is typically in the lower range of the licensed dose, between 20 mg and 40 mg fluoxetine equivalents 5.
Considerations for Diabetic Patients
- When treating anxiety in diabetic patients, it is essential to consider the potential interactions between antidepressants and other medications, as well as the impact of diabetes on the metabolism and efficacy of these medications.
- There is limited information available on the specific treatment of anxiety in diabetic patients, and more research is needed to determine the most effective and safe treatment options for this population.
Available Treatment Options
- Based on the available evidence, the following SSRIs may be considered as first line treatment options for anxiety in diabetic patients: