1 st time in India

To keep the members of

diabetes care team abreast with
DSME and DSMS concepts

EDITORIAL BOARD NATIONAL ADVISORY BOARD

Chief Editors President Dr. Vijay Viswanathan
Dr. L. Sreenivasamurthy, Bengaluru Immediate Past President Dr. Rakesh Sahay
Dr. Amit Gupta, Noida President Elect Dr. Anuj Maheshwari
Secretary General Dr. Sanjay Agarwal
Editorial Board Hon. Joint Secretary Dr. Pratap Jethwani
Dr. G. Vijaykumar, Chennai
Hon. Treasurer Dr. J. K. Sharma
Dr. Krishna Prashanti, Tirupati
Vice President Dr. Sujoy Ghosh
Dr. Subhash Kumar, Patna
Dr. Anjali Bhat, Pune Vice President Dr. L. Sreenivasamurthy
Dr. Shankha Sen, Siliguri All India Members Dr. Aravinda J.
Dr. Mayura Kale, Aurangabad Dr. Manoj Chawla
Dr. Rutul Gokalani, Ahmedabad Dr. N. K. Singh
Ms. Sheryl Salis, Mumbai
Dr. M. Shunmugavelu
Dr. Amit Gupta, North Zone
Advisor
Dr. Jothydev, South Zone
Dr. Sunil Gupta, Nagpur
Dr. Rakesh Parikh, West Zone
Dr. Anil Virmani, East Zone
Co-opted Members Dr. Neeta Deshpande
Dr. Sunil Gupta
Patrons of RSSDI Dr. H.B. Chandalia, Mumbai
Dr. Daya Kishore Hazra, Agra
Dr. Ashok K. Das, Puducherry
Dr. Sidhartha Das, Cuttack
Prof. Samar Banerjee, West Bengal
Dr. Prasanna Kumar, Bangalore
Scan the QR code to access
full library of IDEJ - Dr. P.V. Rao, Hyderabad
https://usvmed.com/ Dr. Jitendra Singh, New Delhi
Dr. V. Mohan, Chennai
Dr. Shashank Joshi, Mumbai
*DSME: Diabetes Self-Management Education, DSMS: Diabetes Self-Management Suppor t
 1 st time in India
To keep the members of
diabetes care team abreast with
DSME and DSMS concepts

FOREWORD

Research Society for the Study of Diabetes in India (RSSDI) founded by Prof. MMS Ahuja in the year 1972 is the biggest
scientific association of healthcare professionals involved in promoting diabetes education and research in India. RSSDI
is happy to collaborate with USV to support their endeavour to make India the ‘Diabetes care capital of the world’.
Through this collaboration, RSSDI would like to strengthen the cadre of diabetes educators by empowering them with
recent updates in diabetes management helping bridge the gap between the physician and the patient. Today, the rule of
50% is prevailing in terms of awareness, detection, treatment and control in T2DM. Our aspiration is to achieve 90-90-
90-90 i.e.90% of people with diabetes should be made aware, 90% should be detected, 90% of those detected should
be treated, and 90% of those treated should reach their goals.
Indian Diabetes Educator Journal (IDEJ) is the first of its kind in India, and the longest running monthly diabetes educator
journal since April 2015 and continues its endeavour to spread awareness, knowledge and enable healthcare teams to
manage individuals with diabetes and empower them for self-care. RSSDI IDEJ will continue to keep the members of
diabetes care team abreast with concepts of Diabetes Self-Management Education/Support (DSME/S) with a reach of
44000 doctors and diabetes educators digitally.
This month's theme, "Mental Well-being and Diabetes" highlights the vital two-way relationship between mental health
and diabetes. It explores how diabetes can impact mental well-being while also acknowledging that mental health
issues can complicate diabetes management. The edition emphasizes the importance of fostering healthy coping
strategies, providing emotional support, and ensuring access to mental healthcare to enhance overall wellness. This
issue of IDEJ aims to inspire diabetes educators to adopt approaches that prioritize the mental health of individuals
living with diabetes. We hope it offers valuable insights to help educators promote mental wellness in diabetes care.
We sincerely thank our contributors for making this issue delightful reading for our readers. We dedicate this journal to all
the healthcare professionals who are working relentlessly towards making “India–The Diabetes Care Capital of the World.”

Sincere Regards,

Dr. Sanjay Agarwal

RSSDI Secretary

Disclaimer: This Journal provides news, opinions, information and tips for effective counselling of people with diabetes. This Journal intends to empower your clinic
support staffs for basic counselling of people with diabetes. This journal has been made in good faith with the literature available on this subject. The views and
opinions expressed in this journal of selected sections are solely those of the original contributors. Every effort is
made to ensure the accuracy of information but Hansa Medcell or USV Private Limited will not be held responsible for any inadvertent
error(s). Professional are requested to use and apply their own professional judgement, experience and training and should not
rely solely on the information contained in this publication before prescribing any diet, exercise and medication.
Hansa Medcell or USV Private Limited assumes no responsibility or liability for personal or the injury,
loss or damage that may result from suggestions or information in this book.

*DSME: Diabetes Self-Management Education, DSMS: Diabetes Self-Management Suppor t

Dr. Vijay C. Thaker
MD (Medicine)
Consultant Physician and Cardiologist,
Medicare Hospital, Anand

Article: Silent Strain: The Interplay Between Mental Health and Diabetes

Dr. Shiv Kumar Lath

MD, FEAC
Consultant Physician and Diabetologist,
Dr. Lath Polyclinic, Jharsuda

Article: Spotting the Signs: Screening Mental Well-being in Diabetes

Dr. Rajendra B. Patel

MBBS, Dip. Diabetology,
PGC (Diabetes - Johns Hopkins Institute), CIH
Consultant Diabetologist, Shreeji the Diabetes Clinic, Vadodara

Article: Pharmacotherapy for Psychological Conditions and

Metabolic Risk in Diabetes

Dr. Ajay Budhwar

MBBS, MD, PhD (HC), FACE (Endo USA), MBA (EMPH),
PGDE (Endocrinology), MACE (USA), MADA (USA),
PGDD (Diabetes and Endocrinology, UK)
Chief Consultant and CEO, Budhwar Super Speciality Centre, Amritsar

Article: Key Risk Factors for Depression in Diabetes

Dr. Mayura Kale

MBBS, D. Diabetology, DNB (Medicine)
Consultant Diabetologist and Physician,
Dr. Kale's Diabetes and Psychiatry Clinic, Aurangabad

Article: Interview with Dr. Mayura Kale

Dr. Rohini Gajare

MBBS, DD (Mumbai)
Consultant Diabetologist and Thyroid Specialist,
Dr. Rohini's Diabetes and Thyroid Clinic, Mumbai

Article: Understanding Psychological Care in Type 1 Diabetes Mellitus

 Dr. Soumya Sengupta
MBBS, DPH
Consultant Diabetologist, Cardio Diabetic Clinic, Jharkhand

Article: Psychological Treatments: The Role of Cognitive Behavioral

Therapy in Diabetes Management

Dr. Bhanu Pratap Singh Blouria

MBBS, MD (Medicine), FCCM, PGDED
Consultant Physician, Gupta Super Speciality Hospital, Jammu

Article: Work-related Stress and its Association with the Risk of Diabetes

Prof. Dr. A. Naik

MBBS, MD, Dip. in Clinical Endocrinology and Diabetes,
FEACD, PhD (HC) in Diabetes, Fellow in Diabetes (India)
Consultant Diabetologist and Founder of Sweet Life Diabetic's
Care Clinic & Research Center, Rourkela

Article: Tech-driven Mental Health Interventions for People with Diabetes

Dr. Sunil Bhojane

MBBS, MD, C. Diabetes, CCEBDM
Consultant Diabetologist, Siddhiksha Diabetes Clinic,
City Criticare and Century Rayon Hospitals, Thane

Article: Frequently Asked Questions on Mental Well-being and Diabetes

To get featured in the Indian Diabetes Educator Journal you can connect with us on the below mail ID for further
communication: [email protected]
 Issue No. 118, January 2025

Cover Story: Silent Strain: The Interplay Psychological Treatments: The Role of
Between Mental Health and Diabetes

Dr. Vijay C. Thaker

01 Cognitive Behavioral Therapy in
Diabetes Management
Dr. Soumya Sengupta
15
Spotting the Signs: Screening Mental Work-related Stress and its Association
Well-being in Diabetes

Dr. Shiv Kumar Lath

03 with the Risk of Diabetes

Dr. Bhanu Pratap Singh Blouria

18
Pharmacotherapy for Psychological Tech-driven Mental Health Interventions
Conditions and Metabolic Risk in
Diabetes
Dr. Rajendra B. Patel
06 for People with Diabetes

Prof. Dr. A. Naik

21
Key Risk Factors for Depression Frequently Asked Questions on Mental
in Diabetes

Dr. Ajay Budhwar

08 Well-being and Diabetes

Dr. Sunil Bhojane

23
Interview with Dr. Mayura Kale
Did you Know? Tomato Intake is

Dr. Mayura Kale

10 Associated with a Low Depression
Rate 25
Understanding Psychological Care in
Type 1 Diabetes Mellitus

Dr. Rohini Gajare

13 Dia-Games
26
 Cover Story: Silent Strain: The Interplay Between
Mental Health and Diabetes

Diabetes, a global health issue with both

Dr. Vijay C. Thaker microvascular and macrovascular complications,
MD (Medicine)
significantly impacts mental health, with depression
Consultant Physician and Cardiologist, being one of the most common co-occurring
Medicare Hospital, Anand conditions. Individuals with depression experience a
persistently low mood for at least two weeks, along
with at least five of the following symptoms:

Decreased interest or pleasure, altered sleep pattern with insomnia or hypersomnia, poor concentration, changes in appetite with
weight loss or gain, lack of energy, feelings of guilt or worthlessness, psychomotor agitation, and suicidal thoughts. Studies indicate
that depression prevalence is higher among those with prediabetes, undiagnosed diabetes, and previously diagnosed diabetes
compared to those with normal blood glucose levels. The figure below gives an overview of the pathophysiological association
between diabetes and depression.

Biological factors Environmental factors

Deregulation of the HPA axis Intrauterine environment:
Overactive ANS Fetal and maternal stress
Neurodegenerative change Fetal nutrition
Inflammation and cytokines External environment:
Polyol pathway activation Childhood adversity
Microvascular dysfunction Neighborhood environment
Arterial stiffening Poverty

Pathophysiological association between diabetes and depression

Behavioral factors
Diet
Obesity
Physical inactivity
Socioeconomic status
Sleep

Abbreviations: HPA: Hypothalamic-pituitary-adrenal; ANS: Autonomic nervous system

Both have a bidirectional relationship; in addition to the pathophysiological factors involved in depression, certain antidepressants
also increase the risk of diabetes. The combination of diabetes and depression intensifies healthcare challenges, as emotional
distress impacts treatment adherence and self-care, with detrimental effects on glycemic control.

1
They also exacerbate complications, increase mortality–particularly from
cardiovascular causes–and significantly increase healthcare costs due to the
added strain on glycemic control, increased risk of dementia, and extended
hospital stays.
The American Diabetes Association recommends integrating psychosocial
care into routine diabetes management to improve quality of life and health
outcomes through a collaborative, person-centered, and culturally informed
approach by trained professionals. Diabetes care teams are advised to
implement psychosocial screening protocols for mood concerns, stress,
quality of life, resources (financial, social, family, emotional), and psychiatric history, with screenings conducted at the initial visit,
periodically (at least annually) or with any change in disease, treatment, or life circumstances.
While most people with diabetes experience distress rather than mental illness, it’s essential to recognize that negative emotions
are not per se in need of fixing. In most cases, people learn to self-manage
their emotions with the help of family, friends, and supportive healthcare
providers. Here, fostering self-awareness, understanding, and normalization
of emotional responses can be effective strategies for restoring emotional
balance. Health providers can support patients by actively listening, showing
empathy, and helping them find self-management strategies that enhance
their quality of life. Tools like the World Health Organization (WHO)-5 Well-Being
Index can facilitate these conversations by tracking well-being over time and
identifying needs for further support.

When psychosocial concerns are identified, referrals should be made to

qualified behavioral health professionals, ideally those with diabetes
expertise, for evaluation and treatment. Embedding these professionals
within diabetes care settings and using a collaborative team approach
improves diabetes self-management, depression outcomes, and
psychosocial functioning.

Resources:
1. Habib S, Sangaraju SL, Yepez D, Grandes XA, Talanki Manjunatha R. The Nexus Between Diabetes and Depression: A Narrative Review. Cureus.
2022;14(6):e25611. Published 2022 Jun 2. doi:10.7759/cureus.25611.
2. American Diabetes Association Professional Practice Committee; 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:
Standards of Care in Diabetes–2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S77–110. https://doi.org/10.2337/dc24-S005.
3. Snoek FJ. Mental health in diabetes care. Time to step up. Front Clin Diabetes Healthc. 2022, 3:1039192. doi: 10.3389/fcdhc.2022.1039192

2
 Spotting the Signs: Screening Mental Well-being in Diabetes

Diabetes management is a multifaceted endeavor,

Dr. Shiv Kumar Lath extending beyond physical health to encompass
MD, FEAC
mental well-being. People with diabetes often
Consultant Physician and Diabetologist, experience psychological challenges, including
Dr. Lath Polyclinic, Jharsuda diabetes distress, anxiety, and depression, which
can hinder effective self-management and impact
overall quality of life. Epidemiological studies have

shown that people with type 1 or type 2 diabetes face twice the risk of clinical depression compared to the general population, where
prevalence is typically between 5% and 7%.
The emotional burden associated with diabetes self-management, such as
continuous blood glucose monitoring, dietary restrictions, and the fear of
complications, can lead to what is termed “diabetes distress.” This distress
manifests as feelings of frustration, anxiety, and helplessness, which can
impede adherence to treatment and affect patients' quality of life. A significant
amount of psychological distress in diabetes goes unrecognized due to time
constraints in busy clinics. Although many patients want to discuss mental
health with their providers, some prefer confiding in family, friends, or
external professionals. Integrating mental health into diabetes care is
essential, with guidelines recommending regular psychological screening
using standardized tools. The American Diabetes Association (ADA) advises screening at the initial visit, periodically, or with changes
in treatment or life circumstances involving caregivers and family members when appropriate.

Recommended questionnaires and scales

1. Diabetes Distress Scale-17 (DDS-17): The DDS is a widely used tool that helps to measure the emotional burden of individuals
living with diabetes. It consists of 17 items divided into four domains: Emotional strain from living with diabetes, stress from
self-management, social pressures, and challenges with healthcare relationships. It is linked to higher glycated hemoglobin
(HbA1c) levels, elevated blood pressure, and increased low-density lipoprotein (LDL) cholesterol. People with higher diabetes
distress also face a 1.8-fold increase in mortality, a 1.7-fold greater risk of cardiovascular disease, and reduced quality of life.
2. Patient Health Questionnaire (PHQ-9): This 9-item scale is commonly used to screen for major depressive disorder. Given that
depression is prevalent among people with diabetes, the PHQ-9 can provide valuable insights into the mental health status of
patients. However, it cannot detect diabetes distress, meaning this condition may remain undiagnosed and untreated without a
dedicated screening tool.

3
3. Generalized Anxiety Disorder 7-Item Scale (GAD-7): The GAD-7 is used to screen for anxiety disorders. Similar to the PHQ-9, it
assesses the frequency of anxiety symptoms experienced over the last two weeks. High GAD-7 scores in people with diabetes can
indicate significant anxiety that may interfere with diabetes management.
4. World Health Organization-Five Well-Being Index (WHO-5): This brief questionnaire consists of five items that evaluate
general well-being and life satisfaction. It is useful for quickly assessing mental health and can be employed in various healthcare
settings to complement diabetes-specific assessments.
5. Diabetes-Specific Quality of Life Scale (DSQOLS): This scale assesses the impact of diabetes on various aspects of life,
including psychological well-being. A new version of the diabetes quality of life (DQoL) questionnaire was successfully created,
retaining the concepts of “satisfaction,” “impact,” and “worry” across 13 items.
People with diabetes should undergo regular screening for psychological distress (e.g., diabetes distress, fear of hypoglycemia) and
mental health disorders, with referrals to specialized care if needed. Collaborative, interprofessional teams and psychosocial
interventions (e.g., cognitive behavioral therapy [CBT], motivational support, stress management, family therapy) are
recommended to improve mental health, adherence to treatment, and glycemic control. Children and adolescents require specific
screening protocols for depression, family distress, and body image concerns. Regular metabolic monitoring is advised for those on
antipsychotic medications due to potential adverse effects. Prioritizing mental health alongside physical health enhances the quality
of life for people with diabetes, promoting a more holistic approach to care.

4
 Key points

¢ Diabetes distress, anxiety, and depression are common, impacting self-management and quality of life.
¢ ADA advises screening at the initial visit, periodically, or with changes in treatment or life circumstances, involving caregivers
and family members when appropriate.
¢ DDS-17, PHQ-9, GAD-7, WHO-5, and DQoL scales are recommended to assess psychological well-being.
¢ Interprofessional teams and psychosocial interventions (e.g., CBT, motivational support, stress management) are
recommended to enhance mental health, treatment adherence, and glycemic control.

Resources:
1. Diabetes and Mental Health, Robinson, David J, et al. Canadian Journal of Diabetes. Volume 42, S130–41.
2. Screening tool provides insight to the depths of diabetes-related distress (2022) DiabetesontheNet. Available at: https://diabetesonthenet.com/
journal-diabetes-nursing/screening-tool-provides-insight-to-the-depths-of-diabetes-related-distress/
3. Snoek FJ. Mental health in diabetes care. Time to step up. Front Clin Diabetes Healthc. 2022;3:1039192. Published 2022 Oct 13. doi:10.3389/
fcdhc.2022.1039192
4. Habib S, Sangaraju SL, Yepez D, Grandes XA, Talanki Manjunatha R. The Nexus Between Diabetes and Depression: A Narrative Review. Cureus.
2022;14(6):e25611. Published 2022 Jun 2. doi:10.7759/cureus.25611
5. Bujang MA, Adnan TH, Mohd Hatta NKB, Ismail M, Lim CJ. A Revised Version of Diabetes Quality of Life Instrument Maintaining Domains for Satisfaction,
Impact, and Worry. J Diabetes Res. 2018;2018:5804687. Published 2018 Jul 22. doi:10.1155/2018/5804687

5
 Pharmacotherapy for Psychological Conditions and
Metabolic Risk in Diabetes

The treatment of psychological conditions often

Dr. Rajendra B. Patel involves the use of psychotropic medications,
MBBS, Dip. Diabetology,
which are essential for managing mental health
PGC (Diabetes - Johns Hopkins Institute), disorders such as depression, anxiety, schizophrenia,
CIH
and bipolar disorder. While these medications can
Consultant Diabetologist, Shreeji the Diabetes
Clinic, Vadodara be effective in alleviating symptoms, they also
carry significant risks, particularly concerning

metabolic health. Specifically, many psychotropic medications have been linked to an increased risk of metabolic syndrome (MetS),
type 2 diabetes mellitus (T2DM) and associated conditions such as cardiovascular diseases.

How psychotropic medications increase the risk of diabetes

The relationship between psychotropic medications and metabolic disturbances is well-documented in the literature. Numerous
studies have shown that certain classes of medications, particularly antipsychotics, have profound effects on weight gain, insulin
sensitivity, and glucose metabolism.
1. Weight gain
Many antipsychotic medications, especially second-generation (atypical)
antipsychotics like olanzapine and clozapine, are associated with significant
weight gain. This weight gain is not merely a cosmetic issue; it is a substantial
risk factor for the development of insulin resistance and T2DM. Research
indicates that patients on these medications can experience an increase in
body weight by an average of 5%–10% within the first few months of
treatment. For example, a study found that users of antipsychotics had a
three-fold increased risk of developing T2DM compared to non-users, with
this risk being apparent within the first year of treatment.
2. Insulin resistance
The mechanisms by which psychotropic medications contribute to insulin resistance are complex. Some medications disrupt
normal glucose metabolism by impairing insulin secretion from the pancreas or increasing insulin resistance in peripheral tissues.
For instance, clozapine has been shown to not only promote weight gain but also directly impair insulin secretion. This dual action
significantly raises the risk of developing hyperglycemia and, eventually, T2DM.

6
3. Dyslipidemia
In addition to weight gain and insulin resistance, psychotropic medications
can lead to dyslipidemia, which further compounds the risk for T2DM and
cardiovascular diseases. Elevated triglycerides and low levels of high-density
lipoprotein (HDL) cholesterol are common among patients taking certain
antipsychotics.
4. Increased risk for MetS
The prevalence of MetS is markedly higher in individuals with serious mental
illness compared to the general population. Patients with schizophrenia
or bipolar disorder often exhibit multiple components of MetS, including obesity, hypertension, and dyslipidemia. Studies suggest
that this increased prevalence is partly due to the metabolic side effects of antipsychotic medications.

Conclusion

The use of psychotropic medications plays a significant role in increasing the risk of MetS and type 2 diabetes among individuals
with psychological conditions, highlighting the importance of monitoring metabolic health in these individuals. While management
strategies such as lifestyle modifications and medication adjustments are crucial, understanding the inherent risks associated with
psychotropic pharmacotherapy is essential for healthcare providers to ensure comprehensive care for their patients. Addressing
both mental health needs and metabolic risks can lead to better overall health outcomes in this vulnerable population.

Key points

¢ Psychotropic medications for mental health conditions can increase the risks of diabetes and MetS, mainly through weight
gain, insulin resistance, and dyslipidemia.
¢ Second-generation antipsychotics, like olanzapine and clozapine, are especially linked to these effects.
¢ Regular metabolic monitoring and lifestyle adjustments are crucial for managing these risks and improving patient outcomes.

Resources:
1. Bobo WV, Cooper WO, Stein CM, et al. Antipsychotics and the risk of type 2 diabetes mellitus in children and youth. JAMA Psychiatry.
2013;70(10):1067–75.
2. Filaković P, Petek Erić A, Radanović-Grgurić L. Metabolic syndrome and psychotropic medications. Med Glas (Zenica). 2012;9(2):180–8.
3. Llorente MD, Urrutia V. Diabetes, psychiatric disorders, and the metabolic effects of antipsychotic medications. Clin Diabetes. 2006;24(1):18–24.
4. Scheen AJ. Metabolic disorders induced by psychotropic drugs. Ann Endocrinol (Paris). 2023;84(3):357–63.

7
 Key Risk Factors for Depression in Diabetes

Individuals with diabetes are more likely to develop

Dr. Ajay Budhwar psychological issues, such as depression. Studies
MBBS, MD, PhD (HC), FACE (Endo USA),
have shown that they have a 24% increased risk of
MBA (EMPH), PGDE (Endocrinology), developing depression. The interplay between
MACE (USA), MADA (USA), diabetes and depression can lead to prolonged
PGDD (Diabetes and Endocrinology, UK)
depressive episodes and a higher likelihood of
Chief Consultant and CEO, Budhwar Super
Speciality Centre, Amritsar recurrence. Some studies report a higher
prevalence of depression among younger

individuals with diabetes, while others show a greater prevalence in older adults. For younger individuals, this may be due to greater
exposure to stress, conflicts, and fear of the unknown future. Among older individuals, the increased risk may stem from the long
duration of the disease and a higher likelihood of diabetes-related complications.
The risk factors for developing depression in individuals with diabetes are as follows:
¢ Female sex
¢ Adolescents/young adults and older adults
¢ Poverty
¢ Few social supports
¢ Stressful life events
¢ Poor glycemic control, particularly recurrent hypoglycemia
¢ Higher illness burden
¢ Longer duration of diabetes
¢ Presence of long-term complications
The clinical condition of individuals with diabetes is worsened by comorbid depression. This may be due to the accompanying
lethargy, which reduces motivation for self-care, leading to decreased physical and psychological fitness, increased use of
healthcare services, and lower adherence to prescribed regimens. Additionally, depression appears to increase cardiovascular
mortality. One study reported that the factor most strongly associated with the highest prevalence of depression was the need for
insulin.
Depression can intensify the symptom burden for individuals with diabetes by approximately fourfold. Therefore, understanding
these risk factors is essential for healthcare providers to identify those at greater risk for depression.

8
Resources:
1. Diabetes Canada Clinical Practice Guidelines Expert Committee, Robinson DJ, Coons M, Haensel H, Vallis M, Yale JF. Diabetes and Mental Health.
Can J Diabetes. 2018;42 Suppl 1:S130–41.
2. Abuhegazy H, Mujairi A, Banah F, et al. Depression and Associated Risk Factors Among Type 2 Diabetic Patients: A Cross Sectional Study on a
Convenience Sample from the Diabetic Center, Khamis Mushait; Saudi Arabia. Neuropsychiatr Dis Treat. 2022;18:1975–84.

9
 Interview with Dr. Mayura Kale

Dr. Mayura Kale is a highly respected consultant diabetes specialist at Dr. Kale's
Diabetes and Psychiatry Clinic in Aurangabad, bringing over 20 years of
experience to her work. Known for her holistic approach, she focuses on
managing diabetes and lifestyle disorders through sustainable health practices
and individualized care. Her dedication to patient education and long-term health
outcomes has made a positive impact on countless lives. Dr. Kale has served as a
Dr. Mayura Kale consultant at a 150-bed multispecialty hospital, presented at conferences, and
MBBS, D. Diabetology, DNB (Medicine) lectured extensively. She has also been a brand ambassador for diabetes
Consultant Diabetologist and Physician, prevention campaigns and volunteered during the COVID-19 pandemic,
Dr. Kale's Diabetes and Psychiatry Clinic,
Aurangabad impacting thousands of lives with her compassionate, patient-centered care.

Mental Well-being and Diabetes

1. What are the most common mental health challenges faced by individuals with diabetes?
Ans. Depression, anxiety, and diabetes distress are a few common health challenges faced by individuals with diabetes.

10
2. In your experience, how often do you see conditions like depression, anxiety, or other psychological disorders in your
patients with diabetes, and how do these affect their overall health?
Ans. Depression, anxiety, and other psychological disorders are observed in as many as 30%–40% of patients with diabetes.
Individuals with diabetes often experience feelings of frustration, guilt,
and anxiety related to managing their condition, which can lead to
emotional exhaustion and burnout. High levels of diabetes distress are
associated with lower self-care behaviors, such as reduced physical
activity, unhealthy eating habits, and neglecting medication adherence.
Those experiencing diabetes distress tend to have higher glycated
hemoglobin (HbA1c) levels, indicating poor glycemic control, which
increases the risk of complications. The stress of managing diabetes
can lead to feelings of isolation and avoidance of social interactions,
further exacerbating emotional difficulties. Managing diabetes can
strain personal relationships due to mood swings. The constant demands of self-care can make it challenging for individuals to
maintain healthy connections with others.
Overall, diabetes can create a cycle that negatively affects both physical health and emotional well-being.
3. What advice do you have for patients who experience emotional burnout from managing their diabetes on a daily basis?
Ans. I usually advise patients to incorporate relaxation techniques like deep breathing, yoga, or mindfulness in their daily routine to
help manage stress levels. Sharing feelings with friends, family, or support groups is a good way to reduce burnout. Talking
about their experiences and challenges can alleviate some emotional burdens and help them feel less isolated. Sometimes, it
is advisable to avoid high expectations regarding blood glucose levels. Focusing on smaller, achievable goals can reduce
stress. This could mean relaxing their targets or reducing how often they check blood glucose after consultation with the
healthcare team. Engaging in activities that bring them joy and relaxation, such as hobbies, is encouraged. Individuals with
diabetes, especially with type 1 diabetes, can be encouraged to join support forums or groups to share experiences and coping
strategies. If feelings of distress persist, patients can be referred to a mental health professional who understands
diabetes-related issues.

11
4. How can family, friends, and caregivers support the mental well-being of someone with diabetes?
Ans. Family and friends should be good listeners and allow an individual with
diabetes to express their feelings, experiences, and challenges about
living with diabetes. They should remember that mood swings may
occur due to fluctuations in blood glucose levels and offer support
without criticism. Knowledge about diabetes enables the caregiver to
provide informed support and encouragement. Caregiver should
reinforce that the individual with diabetes is not alone in managing
his/her condition. Caregivers should also adopt healthy eating and
exercise habits for individuals with diabetes. This shared commitment
can enhance motivation and make lifestyle changes more enjoyable.
Organizing activities that promote physical health, such as walking or cooking healthy meals together, can serve as bonding
experiences. Acknowledge their successes, no matter how small. Suggest stress-reducing activities like yoga, mindfulness,
or even watching a funny movie together. By implementing these strategies, family and friends can significantly enhance the
optimism of someone living with diabetes, contributing to better emotional health and improved management of the condition.
5. How do you envision the future role of mental healthcare in the treatment and management of diabetes?
Ans. Future diabetes care will likely include regular mental health assessments as part of standard care protocols. Utilizing
standardized questionnaires can help identify patients at risk for mental health issues, allowing for timely interventions.
Interventions that promote psychological well-being, such as mindfulness-based therapies and resilience training, are
expected to become common practice. These programs will enhance self-efficacy and motivation in diabetes
self-management, leading to better glycemic control and overall health outcomes. The use of digital tools and applications for
monitoring mental health will likely increase.

12
 Personalized Dietary Intervention to Improve Diabetes Outcomes:
A Doctor's Experience on the MyCare Patient Support Program

An 18-year-old girl with type 1 diabetes was

Dr. Priyanka Shah managed by Dr. Priyanka Shah.
MBBS, MD (Medicine), MRCP (Endocrinology),
Fellowship in Endocrinology and Diabetes
Associate Professor,
Government Medical College, Surat

Here's what Dr. Priyanka Shah has to say:

An 18-year-old girl with type 1 diabetes presented with uncontrolled blood glucose levels. Her HbA1c was 11.2%, fasting blood
glucose levels were 215 mg/dL, and postprandial blood glucose levels were 306 mg/dL. She was taking 64 units of bolus insulin and
46 units of basal insulin. A detailed history revealed unhealthy eating habits, including a high intake of refined carbohydrates and
junk foods of poor nutritional value, which contributed to her elevated blood glucose levels.
To address these concerns, MyCare Diabetes Educator (MDE), Ms. Khushboo Tilwani, guided her in improving her eating habits. She
played a pivotal role in educating her about the effects of refined carbohydrates and suggested healthier, low glycemic index
alternatives to support both glucose control and ensure adequate nutrition. She also advised easy ways to include sufficient protein
in her meals.
She recommended a personalized meal plan tailored to the insulin regimen. This meal plan helped synchronize her food intake with
insulin action, reducing blood glucose spikes. By aligning meals with insulin doses, it simplified her diabetes management, making
insulin therapy more predictable and less burdensome. This structured approach enhanced her confidence and improved her
adherence to insulin injections as well.
She was instructed to monitor her blood glucose levels regularly and maintain detailed records. With these modifications, her HbA1c
dropped to 8.5%, and her fasting and postprandial glucose levels reduced to 115 mg/dL and 85 mg/dL, respectively. As a result, her
insulin requirements also decreased to 50 units of bolus insulin and 40 units of basal insulin. Through personalized dietary
intervention, consistent monitoring, and a positive approach to health, she has made remarkable progress. She now adheres to a
structured meal plan that ensures balanced nutrition and has significantly reduced her need for higher insulin dosages.

Here's what MDE Khushboo Tilwani has to say:

MDE Khushboo Tilwani This story is a testament to the power of personalized
NDEP and T1DE Certified Diabetes Educator dietary intervention in managing type 1 diabetes. It
exemplifies the vital role of dietitians and diabetes
educators in enhancing patient outcomes and serves
as an encouraging example for young individuals
battling similar challenges.
 Understanding Psychological Care in Type 1 Diabetes Mellitus

Type 1 diabetes mellitus (T1DM) requires both

Dr. Rohini Gajare physical and psychological care, especially for
MBBS, DD (Mumbai)
children, adolescents, and young adults. Mental
Consultant Diabetologist and Thyroid Specialist, well-being is the key to successful diabetes
Dr. Rohini's Diabetes and Thyroid Clinic, management and better health outcomes.
Mumbai

Interventions recommended to support young individuals with T1DM

1. Family-based and clinic-based psychosocial interventions

Family-based therapy with goal-setting, problem-solving, and shared responsibility reduces conflict and clear communication and
enhances glycemic control. In clinic visits, family teamwork and psychoeducational support from a “care ambassador” further boost
parental involvement, reduce hypoglycemia, and minimize emergency visits. Together, these strategies lead to better diabetes
management for younger children.
2. Peer support programs
Coping skills training in peer groups for adolescents and school-age children improves glycemic control, reduces diabetes-related
stress, and enhances quality of life and social relationships.

13
3. Cognitive behavioral therapy (CBT)
CBT helps individuals identify and change negative thought patterns, making it effective for managing diabetes-related distress and
anxiety around blood glucose monitoring or insulin use. It also builds problem-solving skills, empowering young people to better
handle diabetes challenges.
4. Motivational interviewing (MI)
MI is a counseling approach that enhances a patient's motivation to engage in
their treatment. It's especially beneficial for adolescents who may struggle
with self-management. By focusing on the patient's personal values and
goals, MI fosters self-efficacy, encouraging them to take ownership of their
diabetes care.
5. Technology-assisted interventions
Adolescents with diabetes benefit from behavioral interventions via Skype,
telehealth, text messaging, and chat rooms. More complex online programs targeting glycemic control and emotional regulation
have increased blood glucose monitoring and improved working memory and glycemic control, especially for those with emotional
challenges. Digital tools like apps and online games help foster behavior change and improve self-efficacy but show mixed results
on other health and psychological outcomes.
Incorporating psychological care into T1DM management is crucial for young individuals. Interventions like CBT and peer support
address emotional challenges, improving both mental well-being and diabetes outcomes with early and consistent support.

Resource:
• de Wit M, Gajewska KA, Goethals ER, et al. Psychological care of children, adolescents, and young adults with diabetes. ISPAD Clinical Practice
Consensus Guidelines 2022. Amsterdam UMC, Vrije Universiteit Amsterdam; 2022.

14
 Psychological Treatments: The Role of Cognitive
Behavioral Therapy in Diabetes Management

Introduction
Dr. Soumya Sengupta
MBBS, DPH
Diabetes, a rapidly expanding global chronic
Consultant Diabetologist, Cardio Diabetic Clinic,
Jharkhand disease, imposes a significant psychological toll on
individuals. Self-management activities such as
dietary modifications, physical exercise, adherence

to medications or insulin, self-monitoring, and regular clinic visits can be demanding. Maintaining motivation for these tasks can be
challenging and often results in frustration or burnout.

Psychological challenges in diabetes management

The psychological burden of diabetes can stem from a variety of factors,

including:
¢ Biological aspects, such as fluctuations in blood glucose levels that
impact mood and mental clarity.
¢ Social influences like stigma or familial expectations.
¢ The demands of daily management, which contribute to feelings of
stress and exhaustion.

Psychotherapeutic interventions

Several psychotherapeutic approaches, including motivational interviewing, mindfulness-based therapies, and counseling, have
been found effective in supporting behavior change. Among these, cognitive behavioral therapy (CBT) stands out for its widespread
application and proven efficacy.

CBT

CBT is a focused, structured psychological treatment that emphasizes understanding and modifying current thought patterns and
behaviors. Unlike other psychological treatments, CBT is typically time-limited and is designed to address specific problems in a
practical, hands-on manner.

15
 Core principles of CBT

1. Psychological issues are often rooted in maladaptive thought patterns.

2. Learned, unproductive behaviors contribute to psychological problems.
3. Individuals can develop healthier coping strategies, leading to symptom
relief and improved daily functioning.

Effectiveness of CBT in diabetes management

Over recent decades, extensive research has highlighted the effectiveness of CBT in addressing the psychological aspects of
chronic illnesses, including diabetes. Key findings include:
¢ Psychoeducation and motivation: CBT-based interventions educate individuals about their conditions, increase their
understanding, and help overcome negative thought patterns.
¢ Reduction of psychological distress: CBT significantly reduces diabetes-related distress, depression, and anxiety, leading to
improved quality of life.
¢ Enhanced self-care and adherence: CBT has shown to improve adherence to treatment plans and self-care behaviors,
positively impacting glycemic control.
¢ Promotion of physical activity: CBT techniques can help boost motivation for physical activity, further aiding glucose
management.
¢ Improved emotional regulation: Patients undergoing CBT often report better emotional control, enhanced motivation, and a
more positive outlook.

CBT techniques and strategies

CBT employs various techniques, including:

Cognitive strategies
1. Recognizing and re-evaluating distorted thinking that contributes to
emotional distress.
2. Gaining a deeper understanding of others’ behaviors and motivations.
3. Utilizing problem-solving skills to tackle challenging situations.
4. Building self-confidence and self-efficacy.
Behavioral techniques
1. Facing fears head-on rather than avoiding them.
2. Role-playing to prepare for potentially stressful interactions.

16
 Key points

¢ Diabetes has a substantial psychological impact, with self-management

tasks often leading to frustration and burnout.
Thoughts
¢ Psychological challenges in diabetes stem from biological factors, social
pressures, and the overall burden of disease management.
CBT
¢ CBT is a highly effective psychotherapeutic approach for improving
Behaviors Feelings
mental health outcomes in individuals with diabetes.
¢ CBT helps modify thought patterns and behaviors through targeted
strategies, which include recognizing and reframing negative thinking,
problem-solving, and exposure to feared situations.
¢ Research supports CBT’s role in reducing diabetes distress, depression, and anxiety, while enhancing quality of life, treatment
adherence, and physical activity.

Resources:
1. Harvey JN. Psychosocial interventions for the diabetic patient. Diabetes Metab Syndr Obes. 2015;8:29–43. Published 2015 Jan 9.
doi:10.2147/DMSO.S44352
2. Abbas Q, Latif S, Ayaz Habib H, et al. Cognitive behavior therapy for diabetes distress, depression, health anxiety, quality of life and treatment adherence
among patients with type-II diabetes mellitus: A randomized control trial. BMC Psychiatry. 2023;23(1):86. Published 2023 Feb 3.
doi:10.1186/s12888-023-04546-w
3. American Psychological Association. Cognitive behavioral therapy. Available at: https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-
behavioral.pdf. Accessed October 25, 2024.
4. Gobin K, Mills S, Katz D. Psychotherapeutic Interventions for Type 2 Diabetes Mellitus. In: Psychology and Path physiological Outcomes of Eating.
IntechOpen; 2021. Available from: http://dx.doi.org/10.5772/intechopen.97653

17
 Work-related Stress and its Association
with the Risk of Diabetes

The International Diabetes Federation highlights

Dr. Bhanu Pratap Singh Blouria that the primary need in diabetes prevention is
MBBS, MD (Medicine), FCCM, PGDED
recognizing and addressing social and
Consultant Physician, Gupta Super Speciality environmental factors that can be modified.
Hospital, Jammu Traditional risk factors, such as a family history,
a lack of exercise, high body weight, alcohol,
smoking, and unhealthy diet, are well-established.

New evidence suggests that psychosocial stress, particularly work-related stress, may also have a considerable impact on the risk
of developing type 2 diabetes mellitus (T2DM).
Stress can cause temporary hyperglycemia, even in individuals without diabetes. Under stress, the liver releases extra glucose for
energy, and with chronic stress, the body may struggle to manage this glucose surge, increasing the risk of T2DM.

Link between work stress and T2DM

This link is believed to result from two primary mechanisms: The dysregulation of neuroendocrine responses and lifestyle-related
factors. The body's “fight or flight” response, driven by hormones like epinephrine, growth hormone, and glucocorticoids such as
cortisol, elevates glucose levels and prompts higher insulin output. These hormonal changes brought on by stress, especially those
involving cortisol, may moderate this connection, eventually resulting in insulin resistance and the development of diabetes.
Additionally, long-term stress may have an indirect impact on diabetes risk by influencing lifestyle decisions that contribute to the
risk, such as poor eating habits and decreased physical activity.

18
One study examined the relationship between diabetes incidence and long
work hours in a 12-year sample of workers. It concluded that long work hours
did not increase the risk of developing diabetes among men. However, among
women, those usually working 45 hours or more per week had a significantly
higher risk of diabetes than women working between 35 and 40 hours per week.
This effect may be particularly pronounced among women, as additional
responsibilities and stressors could exacerbate the impact of prolonged work
hours. Another systematic review and meta-analysis of prospective cohort
studies also reported similar results, with females posing a higher risk of
acquiring chronic work-related stress associated with T2DM. Nevertheless, some studies have indicated an increased risk in both
men and women. Chronic burnout, marked by emotional exhaustion, physical fatigue, and cognitive weakness, is estimated to
increase the risk of T2DM by 1.84 times, even after adjusting for related risk factors. Reducing long work hours may lower diabetes
risk, particularly for high-risk groups, underscoring the importance of workplace strategies to manage work hours and alleviate
job-related stress. These findings call attention to the importance of addressing work-related stress as a modifiable risk factor in
diabetes prevention.

Considerations for public health and prevention

Public health initiatives incorporating workplace wellness programs could play a significant role in reducing the incidence of
diabetes associated with occupational stress. Prevention strategies for T2DM may be more effective if psychological stress
responses are identified and complemented by targeted intervention programs. There are very few studies on work stress-induced
diabetes in India, but many studies have been carried out in developed countries. Longitudinal studies in this area are needed to
explore the connections between work hours and work environment, in combination with health behaviors and diabetes, while also
considering related gender differences. This would deepen understanding of these effects and enhance prevention strategies.

19
 Key points

¢ The International Diabetes Federation stresses addressing modifiable social and environmental factors in diabetes prevention
alongside traditional risk factors.
¢ Work-related stress significantly influences the risk of developing T2DM.
¢ Chronic stress elevates glucose levels and may contribute to insulin resistance and diabetes, especially in those with long work
hours.
¢ Long work hours increase diabetes risk, with chronic burnout raising the risk of T2DM by 1.84 times.
¢ Workplace wellness programs and longitudinal studies are essential for understanding work stress and enhancing diabetes
prevention strategies.

Resources:
1. Sui H, Sun N, Zhan L, Lu X, Chen T, Mao X. Association between Work-Related Stress and Risk for Type 2 Diabetes: A Systematic Review and
Meta-Analysis of Prospective Cohort Studies. PLoS One. 2016;11(8):e0159978. Published 2016 Aug 11. doi:10.1371/journal.pone.0159978
2. Gilbert-Ouimet M, Ma H, Glazier R, Brisson C, Mustard C, Smith PM. Adverse effect of long work hours on incident diabetes in 7065 Ontario workers
followed for 12 years. BMJ Open Diabetes Res Care. 2018;6(1):e000496. Published 2018 Jul 2. doi:10.1136/bmjdrc-2017-000496
3. Veena Prabavathy J, Sangeetha R. Stress induced type 2 diabetes mellitus among industrial workers – A review. Res J Pharm Technol.
2019;12(1):396–402. doi:10.5958/0974-360X.2019.00072.6.

20
 Tech-driven Mental Health Interventions for
People with Diabetes

Managing diabetes involves a daily commitment to

Prof. Dr. A. Naik tracking blood glucose levels, food intake, and
MBBS, MD, Dip. in Clinical Endocrinology
physical activity, often leading to stress, anxiety, and
and Diabetes, FEACD, PhD (HC) in Diabetes, depression. Fortunately, technology-driven interventions
Fellow in Diabetes (India)
are making it easier for people with diabetes to manage
Consultant Diabetologist and Founder of Sweet
Life Diabetic's Care Clinic & Research Center, both physical and mental health aspects, fostering
Rourkela emotional resilience and empowerment.

Mobile apps for holistic management

Some apps integrate blood glucose tracking with mood and stress monitoring. Evidence suggests that real-time app feedback
encourages positive self-management behaviors, reducing distress.

Telemedicine and virtual counseling

Telehealth has redefined accessibility to mental healthcare for people with

diabetes. Through virtual consultations, patients can access psychologists,
counselors, and certified diabetes educators to discuss diabetes-related
anxiety and depression without geographical or time limitations.
Telemedicine also facilitates long-term follow-ups, which are crucial for
sustained mental well-being and diabetes management. Platforms offering
cognitive behavioral therapy (CBT) and mindfulness-based interventions via
telehealth have shown effectiveness in reducing diabetes-related distress
and improving quality of life.

Wearable devices and predictive analytics

Wearables like the smartwatch now offer tools for monitoring not just physical activity and sleep but also physiological indicators of
mental stress, such as heart rate variability. When combined with artificial intelligence (AI)-driven analytics, these devices can
predict and alert users to patterns of distress, allowing for timely interventions. Wearable's continuous monitoring supports patients
in maintaining consistent routines and recognizing early signs of stress or burnout.

21
 CBT and gamified support systems

CBT platforms adapted for diabetes provide coping strategies through a structured, evidence-based approach, addressing mental
health challenges unique to diabetes. Some programs even incorporate gamification to make therapy more engaging, using
challenges and reward systems to motivate users for both mental and physical health goals.
By combining technology with personalized mental health strategies, these interventions provide people with diabetes access to
resources that previously required in-person visits. These advancements support emotional resilience and help patients feel more
empowered in their diabetes management journey.

Resources:
1. Sherifali D, Whitmore C, Naeem F, et al. Technology-Enabled Collaborative Care for Type-2 Diabetes and Mental Health (TECC-D): Findings From a
Mixed Methods Feasibility Trial of a Responsive Co-Designed Virtual Health Coaching Intervention. Int J Integr Care. 2024;24(1):12. Published 2024
Feb 16. doi:10.5334/ijic.7608
2. Adeel, Ayesha & Kannangara, Chathu & Bharaj, Harni & Basu, Ambar & Green, Barrie. New Technologies and Interventions to Improve the Mental Health
of People with Diabetes, 2023. Proceedings of ICACTCE'23 –The International Conference on Advances in Communication Technology and Computer
Engineering (pp.753–760). 10.1007/978-3-031-37164-6_53.
3. Varela-Moreno E, Carreira Soler M, Guzmán-Parra J, et al. Effectiveness of eHealth-Based Psychological Interventions for Depression Treatment in
Patients With Type 1 or Type 2 Diabetes Mellitus: A Systematic Review. Front Psychol. 2022;12:746217.

22
 Frequently Asked Questions on Mental Well-being and Diabetes

1. My 15-year-old son has type 1 diabetes and is

Dr. Sunil Bhojane currently preparing for his 10th board exams.
MBBS, MD, C. Diabetes, CCEBDM
His blood glucose levels have been consistently high
Consultant Diabetologist, despite following his usual insulin routine and diet
Siddhiksha Diabetes Clinic, plan. Could the stress and the pressure of exams be
City Criticare and Century Rayon Hospitals,
Thane causing these spikes in his blood glucose? If yes,
how do we manage it?

Ans. Yes, exam stress can indeed contribute to elevated blood glucose levels.
Acute stress triggers the release of stress hormones like adrenaline and
cortisol, which signal the liver to release stored glucose, leading to higher
blood glucose levels. In teens with type 1 diabetes, their body’s inability to
produce insulin to counterbalance these spikes can lead to sustained
hyperglycemia. Exam-related anxiety, lack of sleep, and reduced physical
activity due to increased study time can further complicate blood glucose
management.
Tips to manage stress-induced hyperglycemia
¢ Encourage regular relaxation techniques like deep breathing or meditation: Encourage regular relaxation methods such
as deep breathing or short mindfulness meditation breaks.
¢ Ensure a balanced diet and hydration: Avoid snacking on unhealthy foods and intake of any high glycemic index foods that
are known to increase glucose levels.
¢ Regularly monitor blood glucose levels: Increased monitoring allows for timely adjustments in insulin.
¢ Adjust insulin dosage: Given that his glucose levels are running higher than usual, it may be necessary to adjust his insulin
dose. Consult his healthcare provider for personalized advice on dosage changes during high-stress periods.
¢ Encourage physical activity if possible: Light exercises, like a short walk, stretching, and chair exercises, can help lower
blood glucose and relieve stress.
Managing both mental health and diabetes during high-stress periods is essential to prevent long-term complications.
2. I’m a 45-year-old woman who has been taking antidepressants for the
past 4–5 years. I’ve recently been diagnosed with prediabetes, and I’m
concerned about whether my long-term use of antidepressants could be
contributing to this new diagnosis.
Ans. Long-term use of certain antidepressants may contribute to prediabetes
through several mechanisms. Studies have shown that antidepressants can
impact glucose metabolism and increase the risk of developing insulin
resistance, which can eventually lead to type 2 diabetes. This risk tends to rise
with longer durations of antidepressant use and higher dosages.
23
Studies have also stated that weight gain, a common side effect of many antidepressants, can also lead to insulin resistance.
¢ Monitor blood sugar levels regularly: Regular monitoring can help track any changes in blood glucose and make timely
adjustments to the treatment plan.
¢ Adopt a balanced diet and exercise routine: Eating a healthy diet and incorporating regular physical activity can significantly
improve insulin sensitivity and support overall metabolic health.
¢ Consider a mental health support plan: In addition to medication, lifestyle strategies like mindfulness, counseling, and stress
management techniques can support mental well-being and may also benefit blood glucose control.
Staying informed and taking proactive steps in managing both mental health and prediabetes is key to preventing progression to
type 2 diabetes and ensuring long-term health.
3. My husband was diagnosed with type 2 diabetes but is in denial and
refuses to follow any management plan. How can I help him understand the
seriousness and importance of managing his diabetes?
Ans. Diabetes denial is a common emotional response to a diagnosis. It can
stem from fear, anxiety, or even misunderstanding of the condition. Here are
steps you can take to help someone move past denial and take control of their
diabetes.
¢ Be empathetic: Acknowledge his feelings without judgment. Let him
know that it’s normal to feel overwhelmed or uncertain and that you’re
there to support him.
¢ Educate gently: Share clear, reliable information on the risks of unmanaged diabetes and the benefits of controlling it.
Try sharing stories of others who are successfully managing diabetes to give him a hopeful perspective.
¢ Start small: Encourage simple, achievable steps like cutting sugar intake from foods and beverages, adding short, regular
walks, etc.
¢ Address mental health: If he continues to struggle with acceptance, consider encouraging him to talk to a mental health
professional. Therapy can provide tools for coping with the emotional side of a diabetes diagnosis and address any underlying
fears or anxieties.
¢ Offer support: Join him in making healthy lifestyle changes, showing he’s not alone.

24
 Did you Know? Tomato Intake is Associated
with a Low Depression Rate

The prevalence of depression and associated psychological health issues is increasing due to fast-paced living and modern
lifestyles. One possible reason is the low intake of fruits and vegetables and the high intake of processed foods. This is linked to low
antioxidant intake and a high intake of inflammatory foods. Fruits and vegetables are rich sources of antioxidants in the diet.
A high intake of fruits and vegetables is associated with a decreased incidence of depression, owing to their antioxidant content.
Tomatoes are rich in nutrients and phytochemicals such as lycopene, potassium, iron, folate, and vitamin C. In addition to lycopene
and vitamin C, tomatoes contain other antioxidants like beta-carotene, as well as phenolic compounds such as flavonoids,
hydroxycinnamic acid, chlorogenic acid, homovanillic acid, and ferulic acid. Tomatoes are known to offer several health benefits,
many of which are attributed to their antioxidant content.
A cross-sectional study reported that tomato intake was inversely associated with depressive symptoms. Lycopene, beta-carotene,
and vitamin C—antioxidants found in tomatoes—may contribute to these benefits. Another study examined the mental health and
dietary habits of 986 elderly men and women aged 70 or older. The study found that individuals who ate tomatoes, whether cooked
or raw, 2–6 times per week were 46% less likely to experience depression symptoms than those who ate tomatoes only once a
week or less. Tomatoes are readily available and commonly consumed in Indian cuisine. When part of a balanced diet, tomatoes can
help protect against depression. It's another great reason to eat more fruits and vegetables for better health and happiness.

Resources:
1. Collins EJ, Bowyer C, Tsouza A, Chopra M. Tomatoes: An Extensive Review of the Associated Health Impacts of Tomatoes and Factors That Can Affect
Their Cultivation. Biology (Basel). 2022;11(2):239.
2. Sun J, Li Z, Li Y, Zhang D. Intakes of Specific Categories of Vegetables and Fruits Are Inversely Associated With Depressive Symptoms Among Adults.
J Epidemiol. 2021;31(3):210–19.

25
24
 Dia-Games

Match the following

Column A Column B

1. Cognitive behavioral therapy A. First-line treatment for type 2 diabetes mellitus

2. Tomatoes B. Identify and change negative thought patterns

3. Metformin C. Reduces depression

4. Hospital Anxiety and Depression Scale (HADS) D. Risk factor for developing type 2 diabetes mellitus

5. Elevated body mass index (BMI) E. Screening instrument

Answers: 1: B, 2: C, 3: A, 4: E, 5: D

26
 Scan the QR code to access full library of IDEJ -
https://usvmed.com/

This content and the information in this booklet is only for reference exclusively meant for the registered medical practitioners.
Physicians and other qualified medical practitioners shall use their discretion and professional judgment in prescribing the right drug
to the patients. USV Private Limited does not provide any medical advice, endorse, encourage or promote use of drugs without having
the right advice from the registered medical practitioner. The views expressed by the authors are their own and USV disclaims all
liabilities arising from use of the information. Copying, distribution and circulation of this booklet without the prior written consent of
USV and RSSDI is strictly prohibited.