The White Coat: Endocrinologist, a doctor who has special training and experience in treating people with diabetes.
In the August 2014 issue of Endocrine News, writer Terri D’Arrigo covers the relationship between diabetes and depression. Depression, Distress, and Diabetes is a comprehensive read, but one that you may want to discuss with your “Endo” White Coat. Here are a few highlights:
For people with diabetes, depression acts as a magnifier. It can worsen the pain of diabetes-related neuropathy and wreak havoc on blood glucose by disturbing appetite and sapping the energy required for regular physical activity. Diverse studies such as the Diabetes and Aging Study and the Pittsburgh Epidemiology of Diabetes Complications Study suggest that people with both diabetes and depression have more than twice the risk of early mortality than people who have only diabetes.
Yet more recent evidence, such as research presented by Lawrence Fisher, PhD, professor of family and community medicine at the University of California–San Francisco at the American Diabetes Association’s 74th Scientific Sessions in June 2014, suggests that depressive symptoms in people with diabetes often point not to clinical depression, but to diabetes distress, a separate, if similar, condition. Whereas depression is overarching, diabetes distress is about the emotional burdens of managing diabetes in particular. “Over the past few years, we have found that many cases diagnosed as depression really were more specific to how fed up and discouraged people were with their diabetes. Sometimes people were misdiagnosed,” says William H. Polonsky, PhD, CDE, president of the Behavioral Diabetes Institute and associate clinical professor at the University of California, San Diego. “The catch is that if a patient has diabetes distress, giving that person an antidepressant is not going to make it go away.”
Considering the time constraints of an office visit, endocrinologists tend to shy away from discussing their patients’ emotional state, says Jeffrey S. Gonzales, PhD, associate professor in the Department of Medicine and the Department of Epidemiology and Population Health at the Albert Einstein College of Medicine in New York. “Endocrinologists often feel unprepared to deal with the question of depression with diabetes. They can feel like it’s opening a Pandora’s Box, or probing for things they may not have time to respond to.”
Basic screening and a few targeted questions can provide a starting point for treatment. If the assessments strongly indicate diabetes distress, the patient may need to go no further than the endocrinologist’s office to address it.“With diabetes distress, the endocrinologist, diabetes nurse educator, or other clinicians in the endocrinology practice may be best qualified to talk to the patient because treatment will focus on better diabetes management,” says Gonzalez. However, if screening points to clinical depression, then a referral to a mental health professional is in order. The challenge there is fragmentation in healthcare.
Any tips on how to talk to a white coat about diabetes distress or depression? Feel free to contribute suggestions in the comments section of this post.