By Dr Srinath A, Endocrinologist, BGS Gleneagles Global Hospital
Infectious disease and metabolic diseases such as diabetes, are major health problems worldwide. Similarly, increasing numbers with depression appears to be a global health burden.
Depression in diabetes is an under recognised issue and if not detected early and managed appropriately can have serious impact on individual as both conditions can be challenging to address once the illness progresses.
With COVID-19 pandemic, communicable disease is thriving all the while with increasing incidences of non-communicable diseases such as Diabetes, Hypertension, Hypercholesterolemia which can predispose one to early heart and stroke related events. Depression seems to be almost forgotten since priority lies in management and stabilising acute illness.
With better access to health care and advancement in medical technology there appears to be a lower incidence of individuals suffering from illness and death reduction from dreaded infectious diseases even in developing countries. However, seasonal and endemic infections remain a challenge with further re-emergence due to demographic and climatic changes, frequent travelling, movement of population from rural to urban areas and surge in population.
Harmful interactions do occur between infectious and metabolic diseases that mainly involve the immune system and have an impact on vital organ systems like the liver, pancreas, gut, brain, kidneys, adrenal gland, and adipose tissue. For example, if an acute infection directly affects pancreas the chance of one getting diabetes is high which can have serious metabolic impact since insulin producing cells are affected directly by infection. The alternate way where pancreas can be affected is a chronic or repeated viral exposure that can affect insulin production at a molecular level and has been expressed as autoimmune response.
Brain fogging means clouding of thoughts where clarity can be momentarily affected either due to tight blood glucose control or changes to diet where food absorption can be affected. It is therefore vital for patients to inform these symptoms to healthcare professionals who can then address by making suitable changes to management.
With the current COVID-19 pandemic, we have witnessed a communicable viral pandemic with the existing non-communicable pandemic of metabolic diseases affecting a significant percentage of the world population, thereby affecting both quality of life and poor outcomes.
One needs to understand how these two conditions; diabetes and depression, pose serious health related problems differently. However, it is important to know if depression was diagnosed pre COVID-19 or undiagnosed since both have a different outcome the same way whether Diabetes was diagnosed previously or undiagnosed. If we take both conditions into consideration, depression may exhibit clues where in family or friends may notice a significant change over a short period of time. The individual may start eating less, experience weight loss, sleep problems, concentration issues, mood changes, headache, lack of interest in daily routine and lack of engagement. On the other hand, diabetes might not cause many symptoms in a subgroup of population where individuals can have high blood glucose without symptoms. Another important condition one needs to be aware is pre-diabetes which is diagnosed mainly on routine health checks. Prediabetes can progress quickly into full blown diabetes if suitable measures are not taken to introduce positive changes in one’s lifestyle such as healthy diet and consistent and regular physically activity. Literature mentions that prediabetes can also pose metabolic risks.
It is Important to note that depressed individuals show a higher risk of developing diabetes and patients with diabetes have a higher risk of developing symptoms of depression.
Secondly, patients with diabetes have a higher risk of developing severe COVID-19 as well as developing secondary infections like bacterial or fungal infections.
Thirdly during recovery from COVID-19 illness at any point of time a person’s tendency to develop depression seems to be increased.
Fourthly, lockdown and quarantine measurements during the COVID-19 pandemic has led to an increase in depression.
Therefore, it is of importance to increase the awareness of this interface between depression, diabetes, and COVID-19.
Finally, it is clear that following post-COVID, diabetes and depression may be overlapping it is important to identify early by health care professionals and need to educate individual & their family members as both conditions can be challenging to manage.