From the Guidelines
Anxiety in diabetic patients should be addressed through a combination of screening, referral to mental health professionals, and evidence-based interventions, prioritizing the patient's quality of life and glycemic control. According to the most recent guidelines from 2024 1, anxiety symptoms and diagnosable disorders 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. The guidelines recommend considering screening people with diabetes for anxiety symptoms or diabetes-related worries, and referring those with hypoglycemia unawareness or fear of hypoglycemia to a trained professional for evidence-based intervention 1.
Key sources of diabetes-related anxiety include fears related to hypoglycemia, not meeting blood glucose targets, insulin injections or infusion, and onset of complications. Psychological and behavioral care, such as cognitive behavioral therapy (CBT), can be helpful in addressing symptoms of anxiety in people with diabetes, with benefits on anxiety symptoms, A1C, and depressive symptoms for up to 1 year among adults with type 2 diabetes and elevated symptoms of distress or depression 1. Additionally, specialized behavioral intervention from a qualified professional is needed to treat hypoglycemia-related anxiety, which can include blood glucose awareness training or cognitively focused psychoeducation programs 1.
In terms of specific interventions, a multidisciplinary approach involving both mental health professionals and diabetes care providers yields the best outcomes for these patients. This can include regular physical activity, mindfulness meditation, and diabetes education to reduce disease-related anxiety, as well as sleep hygiene practices and diabetes support groups. First-line medication options, such as SSRIs, should be considered with caution, taking into account their potential impact on blood glucose levels. Overall, addressing anxiety in diabetic patients requires a comprehensive and individualized approach that prioritizes the patient's quality of life and glycemic control.
From the Research
Anxiety in Diabetic Patients
- Anxiety is a common comorbidity in individuals with type 2 diabetes mellitus, and it is associated with poor metabolic outcomes and increased medical complications 2.
- Collaborative care models have been successful in managing depression associated with diabetes, and it is possible that these models could also be effective in treating anxiety in diabetic patients 2.
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are effective treatments for anxiety disorders, including panic disorder and agoraphobia 3, 4, 5.
- SSRIs have been shown to be efficacious in the treatment of panic disorder, with some studies suggesting that they may be more effective than benzodiazepines in the short-term treatment of panic disorder 4, 5.
- However, SSRIs may be associated with more adverse events than benzodiazepines, including diaphoresis, fatigue, nausea, diarrhea, and insomnia 5.
- Antidepressants, including SSRIs, may be effective in individuals with comorbid physical conditions, such as diabetes, although tolerability is a relevant concern 6.
- The efficacy and tolerability of antidepressants in individuals with diabetes and depressive disorders may vary depending on the specific medication and individual characteristics, highlighting the need for personalized treatment approaches 6.