From the Guidelines
Yes, diabetes can mimic generalized anxiety disorder (GAD) due to the overlapping symptoms of hypoglycemia and anxiety. The symptoms of hypoglycemia, such as shakiness, sweating, rapid heartbeat, nervousness, irritability, and difficulty concentrating, can closely resemble those of anxiety disorders, leading to potential misdiagnosis 1. According to the 2023 standards of care in diabetes, anxiety symptoms and diagnosable disorders, including generalized anxiety disorder, are common in people with diabetes, with a lifetime prevalence of 19.5% 1.
Key Considerations
- The connection between diabetes and anxiety works both ways: diabetes can trigger anxiety-like symptoms, and chronic anxiety can affect blood sugar control through stress hormone release.
- People experiencing persistent anxiety symptoms should consider getting their blood sugar checked, particularly if they have risk factors for diabetes such as family history, obesity, or sedentary lifestyle.
- The timing of symptoms can provide clues—anxiety-like symptoms that occur during fasting or several hours after meals may suggest hypoglycemia rather than a primary anxiety disorder.
- Proper diabetes management with regular blood sugar monitoring, appropriate medication, consistent meal timing, and carbohydrate counting can help prevent hypoglycemic episodes that mimic anxiety 1.
Recommendations for Healthcare Professionals
- Consider screening people with diabetes for anxiety symptoms or diabetes-related worries 1.
- Refer people with hypoglycemia unawareness, which can co-occur with fear of hypoglycemia, to a trained professional to receive evidence-based intervention 1.
- Provide specialized behavioral intervention from a trained health care professional to treat hypoglycemia-related anxiety and unawareness 1.
From the Research
Diabetes and Generalized Anxiety Disorder
- Diabetes can have a complex relationship with generalized anxiety disorder (GAD), with some studies suggesting that diabetes may contribute to the development of GAD symptoms 2, 3, 4.
- Research has shown that people with diabetes are more likely to experience anxiety disorders, including GAD, than those without diabetes 5, 3.
- A meta-analysis found that diabetes was positively associated with anxiety symptoms, with a pooled odds ratio of 1.48 (95% CI: 1.27-1.74) 5.
- Another study found that participants with GAD symptoms had a 2-fold higher incidence of type 2 diabetes than those without GAD symptoms 4.
Symptoms and Determinants
- Anxiety symptoms were observed in 48% of patients with diabetes in a cross-sectional study, although only 4% had a GAD score > 10 6.
- Non-native Kuwaiti citizens were significantly more likely to have moderate-to-severe anxiety (AOR: 6.99,95% CI: 1.42-34.43) compared to Kuwaiti nationals 6.
- Participants attending clinic visits every two months were less likely (AOR: 0.30,95% CI: 0.00-0.50) to report moderate-to-severe anxiety symptoms than those attending monthly 6.
Clinical Implications
- The presence of GAD is associated with poorer glucose control and increased report of clinical symptoms of diabetes 2.
- Integrating anxiety screening into diabetes care may improve outcomes for patients with diabetes who are at high risk of developing GAD 6.
- Further research is needed to determine the impact of treating GAD on glucose regulation in patients with diabetes 2.