Psychosocial aspects of diabetes mellitus


  • E. Xhardo University Hospital “Shefqet Ndroqi”, Tirana, Albania
  • F. Agaçi University Hospital “Shefqet Ndroqi”, Tirana, Albania



diabetes mellitus, psychosocial aspects, diabetes distress, psychiatric comorbidities


Complex environmental, social, behavioral, and emotional factors, known as psychosocial factors, influence living with diabetes mellitus (DM), both type 1 and type 2, and achieving satisfactory medical outcomes and psychological well-being. Thus, individuals with DM and their families are challenged with complex, multifa­ceted issues when integrating diabetes care into daily life. To promote optimal medical outcomes and psychological well-being, patient-centered care is essential, defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions”. Lifestyle changes are equally important, in addition to medical interventions in the management of chronic medical diseases or disorders. The impact of DM reaches far beyond the physical symptoms of the disease, often the emotional distress and psychosocial impact on the quality of life of these patients complicates the effective management of their disease. Medical management of DM requires patient implementation of a treatment regimen. Thus, psychosocial factors impacting self-care such as diabetes distress (burdens of DM and its treatment, worries about adverse consequences), lack of social and economic resources, and other psychological states (e.g., depression, anxiety, eating disorders, cognitive impairment), as well as health literacy and numeracy, should be monitored. Evaluation is indicated during major disease and life transitions, including the onset of complications and significant changes in treatment or life circumstances, with prospective monitoring for 6 months. Future direction in diabetic care should be to screen patients early and often and prevent the diabetes distress. This should be considered a priority while developing a treatment plan not an afterthought.


Download data is not yet available.


Tareen RS, Tareen K. Psychosocial aspects of diabetes management: dilemma of diabetes distress. Transl Pediatr. 2017;6(4):383-396. doi:10.21037/tp.2017.10.04.

Kreider KE. Diabetes Distress or Major Depressive Disorder? A Practical Approach to Diagnosing and Treating Psychological Comorbidities of Diabetes. Diabetes Ther. 2017;8(1):1-7. doi:10.1007/s13300-017-0231-1.

Chew BH, Shariff-Ghazali S, Fernandez A. Psychological aspects of diabetes care: Effecting behavioral change in patients. World J Diabetes. 2014;5(6):796-808. doi:10.4239/wjd.v5.i6.796.

Adriaanse MC, Snoek FJ. The psychological impact of screening for type 2 diabetes. Diabetes Metab Res Rev. 2006;22(1):20-25. doi:10.1002/dmrr.590.

Gonzalez JS, Tanenbaum ML, Commissariat PV. Psychosocial factors in medication adherence and diabetes self-management: Implications for research and practice. Am Psychol. 2016;71(7):539-551. doi:10.1037/a0040388.

Cameron DS, Bertenshaw EJ, Sheeran P. The impact of positive affect on health cognitions and behaviours: a meta-analysis of the experimental evidence. Health Psychol Rev. 2015;9(3):345-365. doi:10.1080/17437199.2014.923164.

Fisher L, Polonsky WH, Hessler D. Addressing diabetes distress in clinical care: a practical guide. Diabet Med. 2019;36(7):803-812. doi:10.1111/dme.13967.

Urata K, Hashimoto K, Horiuchi R, Fukui K, Arai K. Impact of Diabetes Perceptions on Medication Adherence in Japan. Pharmacy (Basel). 2019;7(4):144. doi:10.3390/pharmacy7040144.

Kalra S, Jena BN, Yeravdekar R. Emotional and Psychological Needs of People with Diabetes. Indian J Endocrinol Metab. 2018;22(5):696-704. doi:10.4103/ijem.IJEM_579_17.

Ghosh S, Chatterjee S. Should depressive patients undergo a regular diabetes screening test?. Indian J Endocrinol Metab. 2013;17(3):537-538. doi:10.4103/2230-8210.111692.

Nicolucci A, Kovacs Burns K, Holt RI, et al. Diabetes Attitudes, Wishes and Needs second study (DAWN2™): cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabet Med. 2013;30(7):767-777. doi:10.1111/dme.12245.

Izard CE. Emotion theory and research: highlights, unanswered questions, and emerging issues. Annu Rev Psychol. 2009;60:1-25. doi:10.1146/annurev.psych.60.110707.163539.

Bener A, Ghuloum S, Al-Hamaq AO, Dafeeah EE. Association between psychological distress and gastrointestinal symptoms in diabetes mellitus. World J Diabetes. 2012;3(6):123-129. doi:10.4239/wjd.v3.i6.123.

Laake JP, Stahl D, Amiel SA, et al. The association between depressive symptoms and systemic inflammation in people with type 2 diabetes: findings from the South London Diabetes Study. Diabetes Care. 2014;37(8):2186-2192. doi:10.2337/dc13-2522.

Lima BB, Hammadah M, Kim JH, et al. Association of Transient Endothelial Dysfunction Induced by Mental Stress With Major Adverse Cardiovascular Events in Men and Women With Coronary Artery Disease. JAMA Cardiol. 2019;4(10):988-996. doi:10.1001/jamacardio.2019.3252.

Skinner TC, Carey ME, Cradock S, et al. Depressive symptoms in the first year from diagnosis of Type 2 diabetes: results from the DESMOND trial. Diabet Med. 2010;27(8):965-967. doi:10.1111/j.1464-5491.2010.03028.x.

Sullivan MD, Katon WJ, Lovato LC, et al. Association of depression with accelerated cognitive decline among patients with type 2 diabetes in the ACCORD-MIND trial. JAMA Psychiatry. 2013;70(10):1041-1047. doi:10.1001/jamapsychiatry.2013.1965.

Park M, Katon WJ, Wolf FM. Depression and risk of mortality in individuals with diabetes: a meta-analysis and systematic review. Gen Hosp Psychiatry. 2013;35(3):217-225. doi:10.1016/j.genhosppsych.2013.01.006.

Baumeister H, Hutter N, Bengel J. Psychological and pharmacological interventions for depression in patients with diabetes mellitus and depression. Cochrane Database Syst Rev. 2012;12:CD008381. doi:10.1002/14651858.CD008381.pub2.

Das-Munshi J, Stewart R, Ismail K, Bebbington PE, Jenkins R, Prince MJ. Diabetes, common mental disorders, and disability: findings from the UK National Psychiatric Morbidity Survey. Psychosom Med. 2007;69(6):543-550. doi:10.1097/PSY.0b013e3180cc3062.

Bădescu SV, Tătaru C, Kobylinska L, et al. The association between Diabetes mellitus and Depression. J Med Life. 2016;9(2):120-125.

Roy T, Lloyd CE. Epidemiology of depression and diabetes: a systematic review. J Affect Disord. 2012;142 Suppl:S8-S21. doi:10.1016/S0165-0327(12)70004-6.

Li HQ, Chi S, Dong Q, Yu JT. Pharmacotherapeutic strategies for managing comorbid depression and diabetes. Expert Opin Pharmacother. 2019;20(13):1589-1599. doi:10.1080/14656566.2019.1622090.

Nouwen A, Winkley K, Twisk J, et al. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia. 2010;53(12):2480-2486. doi:10.1007/s00125-010-1874-x.

Mezuk B, Eaton WW, Albrecht S, Golden SH. Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care. 2008;31(12):2383-2390. doi:10.2337/dc08-0985.

Mommersteeg PM, Herr R, Pouwer F, Holt RI, Loerbroks A. The association between diabetes and an episode of depressive symptoms in the 2002 World Health Survey: an analysis of 231,797 individuals from 47 countries. Diabet Med. 2013;30(6):e208-e214. doi:10.1111/dme.12193.

Fisher L, Skaff MM, Mullan JT, et al. Clinical depression versus distress among patients with type 2 diabetes: not just a question of semantics. Diabetes Care. 2007;30(3):542-548. doi:10.2337/dc06-1614.

Swardfager W, Yang P, Herrmann N, et al. Depressive symptoms predict non-completion of a structured exercise intervention for people with Type 2 diabetes. Diabet Med. 2016;33(4):529-536. doi:10.1111/dme.12872.

Joensen LE, Tapager I, Willaing I. Diabetes distress in Type 1 diabetes – a new measurement fit for purpose. Diabet Med. 2013;30(9):1132-1139. doi:10.1111/dme.12241.

Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: Classification and criteria changes. World Psychiatry. 2013;12(2):92-98. doi:10.1002/wps.20050.

Moulton CD, Pickup JC, Ismail K. The link between depression and diabetes: the search for shared mechanisms. Lancet Diabetes Endocrinol. 2015;3(6):461-471. doi:10.1016/S2213-8587(15)00134-5.

Davidson J. Diabulimia: how eating disorders can affect adolescents with diabetes. Nurs Stand. 2014;29(2):44-49. doi:10.7748/ns.29.2.44.e7877.

Jones DE, Greenberg M, Crowley M. Early Social-Emotional Functioning and Public Health: The Relationship Between Kindergarten Social Competence and Future Wellness. Am J Public Health. 2015;105(11):2283-2290. doi:10.2105/AJPH.2015.302630.

Hood KK, Beavers DP, Yi-Frazier J, et al. Psychosocial burden and glycemic control during the first 6 years of diabetes: results from the SEARCH for Diabetes in Youth study. J Adolesc Health. 2014;55(4):498-504. doi:10.1016/j.jadohealth.2014.03.011.

Almeida OP, McCaul K, Hankey GJ, et al. Duration of diabetes and its association with depression in later life: The Health In Men Study (HIMS). Maturitas. 2016;86:3-9. doi:10.1016/j.maturitas.2016.01.003.

Lutter M. Emerging Treatments in Eating Disorders. Neurotherapeutics. 2017;14(3):614-622. doi:10.1007/s13311-017-0535-x.




How to Cite

Xhardo, E., & Agaçi, F. (2021). Psychosocial aspects of diabetes mellitus. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), 16(5), 427–431.



Literature Review