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Problems That Extend Visit Time and Cost in Diabetes Care: 1. How Depression May Affect the Efficacy and Cost of Care of Diabetic Patients

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	Introduction

 
In theory, depression should stand out as a condition that would negatively affect the success of therapy in diabetic patients or patients with impaired glucose tolerance. Depression is known to negatively alter eating patterns, sleep patterns, and activity levels. All of these influences could adversely affect the success of lifestyle modification in diabetic patients. In addition, depression may reduce the ability of patients to carry out complex tasks, such as those required for diabetes self-care.

Given these links, it is surprising that the available literature on interactions between the two conditions is so sparse. Recently, a major review of the possible interactions was published for psychiatrists.¹ This emphasized how many influences insulin resistance and diabetes might exert on depression. Therefore, it also seems important to examine the possible effects depression may have on diabetes.

	Effects of Depression on Diabetes Control and Diabetic Crisis

 
Psychiatric conditions increase the frequency of diabetic crisis in children and adolescents, and depression is an important component of that influence.^2,3 Depression may also play a role in the occurrence of "brittle" diabetes.⁴ Therefore, identifying depression and instituting treatment have been cited as important clinical interventions for people with type 1 diabetes who have recurrent diabetic crises.^5,6

These observations may underscore a much broader, negative interaction between . . . [Full Text of this Article]

	Influences of Depression on Incidence and Prevalence of Diabetes

 

	Effects of Depression on Glycemic Control and Clinical Status in Diabetic Patients

 

	Implications for Outpatient Care

 

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