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Do they go together? Sometimes.
More Depression –
People with diabetes are more likely to be depressed than those who don't have it. However, having diabetes does not mean that you are depressed! ( NIMH)
Worse Control – Type I –
People with diabetes who are depressed are more likely, on average, to have worse diabetic control. (In one study, depressed people with Type I diabetes had HA1C's an average of one point higher than nondepressed people.)
Worse Control – Type II
People with Type II diabetes who are depressed have been shown to not take medication as regularly, to be more overweight and have worse fat levels in their blood (Lin et al, 2004).
Depression may make people less tolerant of pain. If you are depressed and you do have physical pain, you may be more troubled by that pain than a person who is not depressed. (Lustman, 2002)
Which comes first – diabetes or depression?
We don't know yet. Is it the stress of diabetes, or worry about complications, or feelings about limitations, that makes some people with diabetes depressed? For some people with type II, do people who are already depressed move around less, and soothe themselves with food, and then develop diabetes?
Or, are there unknown biochemical reasons for both? Speculations:
For people with Type II, is it depression that causes a pattern of sedentariness, weight gain and poor nutrition, that then leads to diabetes? But, there are many people who develop Type II without being overweight. Does depression cause poorer metabolism that results in higher blood sugars? People who are depressed are actually more likely to develop diabetes. Researchers don't know whether this is caused by chemical imbalances from the depression, or whether a depressed person simply doesn't have the energy to lead a healthier lifestyle (including maybe eating for comfort?) and then develops type II because of the lifestyle (and a genetic predisposition).
Okay. So we know that people who are depressed have poorer self-care behavior that results in worse blood sugars, higher fat levels, less exercise and more obesity. This is a good reason to pay attention to depression as a serious public health problem.
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