People at high risk for developing type 2 diabetes who participate in a lifestyle intervention program that promotes reducing calories and increasing physical activity can reduce their risk of developing the disease by as much as 58 percent!


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    The American Diabetes Association recommends that psychological assessments be a routine part of diabetes management.


      People who have diabetes are twice as likely to suffer from depression as people who do not have diabetes. In fact, from the time someone is diagnosed with diabetes, they have a 1 in 4 chance of developing depression (if they don’t already have it). This has prompted the American Diabetes Association to recommend psychological assessments as a routine part of diabetes management (1).


      Depression can have a detrimental effect on a patient’s engagement in their own care and their adherence to treatment protocols. A 2008 study in Diabetes Care analyzed 47 previous studies of people with type 1 or type 2 diabetes, and found that depression kept them from seeing their doctor, following a diet, and taking medication as directed resulting in complications and increased mortality (2). In another study, researchers found that clinically depressed people with diabetes were three times as likely to die over the 20-year study as those without depression, even after accounting for factors such as age, blood pressure, and smoking (3). This suggests that depression treatment should be a crucial component of any treatment plan.

      Studies have also shown a correlation between existing depression and increased insulin resistance leading to the onset of Type 2 Diabetes. Data suggests that depression in the non-diabetic population is independently associated with up to a 60% increased prospective risk of developing Type 2 Diabetes (4) and that a history of depression may be a risk factor for the development of gestational diabetes mellitus (GDM). These studies suggest that depression may be a greater risk factor for diabetes than is diabetes for depression (5).


      Depression Doubles the Risk of Developing Type 2 Diabetes and Accelerates Development of Diabetes Complications.

      Understanding depression as a medical risk factor for diabetes is an important preventive measure. Screening for and treating depression in people with prediabetes and/or type 2 diabetes may enhance glycemic control and insulin sensitivity, slowing disease progression and reducing comorbid complications (6). However, nearly two-thirds of depressed diabetic patients do not receive antidepressant treatment (7).

      Mean A1C level in relation to depression status after adjusting for weight and total daily insulin dose.

      A1C results were significantly higher in depressed compared to non-depressed subjects and showed a stepwise increase in relation to depression severity within the depressed subject group.  ©2006 by American Diabetes Association


      Most diabetic patients who are experiencing symptoms of depression will seek care from their primary care physician (PCP) rather than seeking care from a mental health professional. Despite their best efforts, many primary care practices struggle to properly diagnose and treat their depressed patients.


      Several barriers can hinder diagnosis and treatment in the primary care setting (8):

      1. Depression is largely an internalizing illness and therefore, can be easy to miss.
      2. Depressed patients are less likely to go to the doctor than patients who are not depressed.
      3. Depressed patients may be unlikely to complain about depression, instead presenting with issues like chronic pain, headaches, insomnia and fatigue.
      4. Physicians may be afraid to ask their patients about depression because of time constraints and a lack of expertise in dealing with psychiatric disorders.
      5. Many physicians view depression as being largely open to subjective interpretation. In spite of this perception, there are validated and reliable measures by which to diagnose depression. For example, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the standard classification of mental disorders used by mental health professionals in the United States and includes a variety of online assessment questionnaires.

      The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the standard classification of mental disorders used by mental health professionals in the United States.

      Additional examples of depression screening tools include but are not limited to:

      • Adult Screening Tools (18 years and older): Patient Health Questionnaire (PHQ-9), Beck Depression Inventory (BDI or BDI-II), Center for Epidemiologic Studies Depression Scale (CES-D), Depression Scale (DEPS), Duke Anxiety-Depression Scale (DADS),Geriatric Depression Scale (GDS), Cornell Scale Screening, and PRIME MD-PHQ2
      • Adolescent Screening Tools (12-17 years): Patient Health Questionnaire for Adolescents (PHQ-A), Beck Depression Inventory-Primary Care Version(BDI-PC), Mood Feeling Questionnaire (MFQ), Center for Epidemiologic Studies Depression Scale (CES-D), and PRIME MD-PHQ2

      Uher, Rudolf, and MUDr. 2015. Psychiatric Times.  Adapted from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).


      Effective Treatments For Depression in Diabetes (9)


      Antidepressant Medications

      1. Tricyclic Antidepressants (TCAs)
      2. Selective Serotonin Reuptake Inhibitors (SSRIs)
        • Fluoxetine
        • Paroxetine
        • Sertraline
        • Buproprion XL


      1. Cognitive Behavioral Therapy
      2. Problem-Solving Therapy
      3. Individual Psychotherapy
      4. Mental Health Providers
      5. Trained Nurse Case Managers
      6. Multidisciplinary Team Care
      • Case identification within primary care practices
      • Psychiatric and medical management to achieve A1c, HTN and cholesterol outcomes

      1  Mezuk, Briana, William W Eaton, and Sherita Hill Golden. “Depression and Type 2 Diabetes Over the Lifespan: a Meta-Analysis.” doi: 10.2337/dc09-0179. Diabetes Care May 2009 vol. 32 no. 5 e57.

      2  Kan, Carol, Naomi Silva, Sherita Hill Golden, Ulla Rajala, Markku Timonen, Daniel Stahl, and Khalida Ismail. “A Systematic Review and Meta-analysis of the Association Between Depression and Insulin Resistance”. Diabetes Care 2013;36:480-489. Diabetes Care August 1, 2013 36:e123.

      3  Gebel, E. PhD. “Depression and Diabetes”. Diabetes Forecast. December 2010.

      4  Kan, Carol, Naomi Silva, Sherita Hill Golden, Ulla Rajala, Markku Timonen, Daniel Stahl, and Khalida Ismail. “A Systematic Review and Meta-analysis of the Association Between Depression and Insulin Resistance”. Diabetes Care 2013;36:480-489. Diabetes Care August 1, 2013 36:e123.

      5  Byrn, M. and Penckofer, S. (2015), The Relationship Between Gestational Diabetes and Antenatal Depression. Journal of Obstetric, Gynecologic, & Neonatal Nursing. doi: 10.1111/1552-6909.12554.

      6  Williams, M M. 2006. “Treating Depression to Prevent Diabetes and Its Complications: Understanding Depression as a Medical Risk Factor.” Clinical Diabetes 24 (2): 79–86. doi:10.2337/diaclin.24.2.79.

      7  Lustman PJ, Clouse RE, Freedland KE. “Management of major depression in adults with diabetes: implications of recent clinical trials”. Semin Clin Neuropsychiatry 3:102 -114, 1998.

      8  Vanderlip ,E. 2015. “5 Reasons Why Depression is Hard to Treat in Primary Care.” Psychiatric Times Blog Post: January 30, 2015.

      9  Diabetes and Depression: Diagnostic and Treatment Considerations


    •  provider Resources



    Detecting and treating chronic diseases in their earliest stages can reduce and sometimes even reverse their negative effects.


    1. BMI ≥ 24 kg/m2 (≥ 22 if Asian)
    2. Diagnosis of prediabetes or Gestational Diabetes Mellitus (GDM) based on one or more of the following:
      • Fasting blood glucose (range 100-125 mg/dl)
      • Oral Glucose Tolerance Test (2 hour range: 140-199 mg/dl)
      • HbA1c (range 5.7-6.4)
      • Previous GDM (may be self-reported)





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    Find low-cost diabetes prevention programs in Colorado


    Read the Guiding Principles for the Care of People With or at Risk for Diabetes


    Find additional resources and educational webinars


    For more, visit the American Diabetes Association

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Educating, engaging and collaborating for a healthier Colorado

      • The American Diabetes Association has a BMI Calculator available on their website to help people assess whether they are at a healthy weight, overweight or obese, at: http://www.diabetes.org/are-you-at-risk/tools-to-know-your-risk/bmi-calculator.html.
      • Could You Have Prediabetes?” Online Test: This simple, seven-question test — available in English and Spanish — assesses a person’s risk for prediabetes. You can view or learn how to share the quiz on your website at www.cdc.gov/diabetes/prevention.
      • A Change for Life” Video: In this video about the National Diabetes Prevention Program, people with prediabetes and experts talk about how type 2 diabetes can be prevented or delayed by making lifestyle changes that include weight loss and increased physical activity. People with prediabetes discuss how the group lifestyle change classes helped them learn and develop healthy habits. You can view and download the video at www.cdc.gov/CDCTV/ChangeForLife/index.html.
      • Knowler, WC, Barrett-Connor, E, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346(6):393-403.
        • Centers for Disease Control and Prevention (CDC). Awareness of Prediabetes - United States, 2005-2010. MMWR Morb Mortal Wkly Rep 2013;62(11);209-212.
        • Centers for Disease Control and Prevention. Diabetes: Am I at Risk? [Fact sheet]. 2013. Retrieved from http://www.cdc.gov/diabetes/prevention/prediabetes.html.
      • American Diabetes Association. Standards of Medical Care in Diabetes – 2012. Diabetes Care 2012;35(Supp 1):S12, table 2. Retrieved from: http://care.diabetesjournals.org/content/35/Supplement_1/S11.full.pdf.
      • American Diabetes Association. Cost of Diabetes. [Fact sheet]. 2013. Retrieved from http://www.diabetes.org/advocate/resources/cost-of-diabetes.html.
      • Tu, HT, Lauer JR. Word of mouth and physician referrals still drive health care provider choice. Health Systems Change 2008, Research Brief No. 9
      • Albright AL, Gregg EW. Preventing type 2 diabetes in communities across the U.S. Am J Prev Med 2013; 44(4):346-51. Retrieved from http://www.ajpmonline.org/article/S0749-3797(13)00016-0/abstract.

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Colorado Prevention Alliance