Diabetes Mellitus and Depression: The Comparison
At first view, diabetes mellitus and depression can be perceived as incomparable diseases. Indeed, diabetes is a physical disorder that is characterized by high levels of blood sugar (glucose) and results from a defect of production or activity of the hormone that is called insulin (Munden, 2007). On the other hand, depression is a mental disorder characterized by the so-called depressive triad: depressed mood and loss of ability to experience pleasure (anhedonia), disturbances of thinking (negative judgments and pessimistic attitude), and motor retardation. It is also characterized by a lowered self-esteem and loss of interest in life and usual activities (Beck & Alford, 2009).
However, these diseases also have certain similarities. In particular, they always result in the negative changes in the organism. Diabetes often leads to the blindness, kidney failure, and damage to the peripheral nervous system (Munden, 2007). Depression usually results in the development of insomnia, loss of appetite, and the worsening of general physical condition of the patient (weight loss and the potential development of arthritis, asthma, and cardiovascular diseases) (Beck & Alford, 2009). Moreover, both of these diseases are among the most widespread and serious ones of the contemporary society. Up to 20% of the U.S. citizens are suffering from diabetes (Munden & Foley, 2007) while depression is the primary cause of disability in the world (Beck & Alford, 2009).
The efforts and methods of diabetes and depression treatment usually vary. In the case of diabetes, timely and correct diagnosis of it plays a major role in its treatment. Treatment for diabetes is aimed at normalizing blood glucose levels and preventing possible complications. It depends on many factors such as the type of diabetes, the severity and controllability of the disease, the existing comorbidities and complications, and the patient’s adherence to treatment (Munden & Foley, 2007). As a result, it requires the active cooperation of the doctor and the patient.
The patient diagnosed with depression does not always require hospitalization, so he/she undergoes outpatient treatment. The main directions of depression treatment are pharmacotherapy, psychotherapy, and social therapy. The most important criterion for a successful antidepressant therapy is the correct clinical diagnosis. An approach to depression treatment should depend on its cause, thus requiring the combined efforts of the physician and the patient or his/her family (Beck & Alford, 2009).
However, in the recent decades, frequent association of these two diseases has attracted the attention of researchers from all over the world. Depression increases the risk of the development of diabetes due to the elevated levels of cortisol (stress hormone) in the blood, which inhibits blood sugar metabolism. At the same time, diabetes increases the risk of the depression development due to the permanent changes in the lifestyle of a person (Munden & Foley, 2007). As a result, it is possible to say that the treatment of these two disorders becomes intertwined, thus combining the abovementioned methods and efforts.
Both of the mentioned diseases place a significant burden on the patient. In particular, diabetes imposes certain limitations on the person’s lifestyle, which many of the patients consider as rather severe. First and foremost, the patient must adhere to a strict medical regimen, namely in the terms of the insulin intake. In addition, many products must be excluded from the patient’s diet. Moreover, he/she must be ready for the potential complications caused by the disease. Finally, chronic diabetes imposes a significant imprint on the social problems of the patient, especially in the terms of employment, limiting his/her choices and opportunities in this area (Munden & Foley, 2007). At the same time, depression changes the overall attitude of the patient as well as his/her perception of the world to the negative side, thus leading to insomnia, lowered self-esteem, and the loss of interest in life. Moreover, major depressive disorders often cause permanent disability and result in coronary heart disease or even suicide (Beck & Alford, 2009).
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Thus, it is possible to say that despite the opposite nature of the diseases, the burden they place on the patient is rather comparable, as both of them result in the serious changes in his/her lifestyle during the treatment. However, in case of diabetes, this burden is still heavier due to the lifetime nature of the disease.
However, the burden is placed not only on the patient but on his/her family as well. In particular, in case of both diabetes and depression, the following issues may arise. The primary of them is the insufficient competency of the people involved in the process of treatment. In particular, diabetes is a disease that requires patients to change their traditional lifestyle, namely in the terms of diet, physical activity, weight control, regular self-control, constant reception of hypoglycemic agents or insulin, etc. However, many patients are not ready to take this step since they fear to change something in their lives. As a result, they require psychological support from the side of the family. It is particularly relevant at the stage of prescription of insulin when the usual pills are ineffective. For a doctor, the prescription of insulin is just a certain stage of the disease while for the patient it is the collapse of many life’s principles and positions (Munden & Foley, 2007).
On the other hand, as a mental disorder, depression primarily influences the patient’s family in a negative way. In this case, psychological support becomes of the utmost importance. However, since depression (especially in its severe form) requires constant control over the patient, many relatives do not have the patience to constantly be on the lookout for him/her (especially in the case of outpatient treatment), which may result in negative consequences for the patient’s physical health (the attempt of self-mutilation or suicide) (Beck & Alford, 2009).
Another important issue that may arise when caring for the patient with either diabetes or depression is the resistance to treatment. In particular, people suffering from diabetes often develop insulin resistance, which has to be overcome by reducing the amount of fat tissue in the body, which again presents additional challenge for the patient and his/her family (Munden & Foley, 2007). In case of resistant depression, the patient is forced to go through such procedures as sleep deprivation (partial or complete), light therapy, and reflexology (Beck & Alford, 2009). All these procedures require additional costs, thus presenting a financial problem for the patient and his/her family.
As any other disorder, both diabetes and depression have certain ethical and legal implications to be considered by the registered nurse (RN) during the treatment. In case of the physical disorder that does not affect the competency of a patient, such as diabetes, the primary ethical as well as legal implication is his/her informed consent. As was mentioned before, the treatment of such illness as diabetes is of a lifetime nature and requires major changes in the patient’s lifestyle. As a result, his/her consent is required for carrying out certain medical procedures such as injections, blood analysis, etc. (Burton & Ormrod, 2011).
For mental health disorder, there are both ethical and legal implications for the failure to render aid to the patient. It means that the provider of healthcare services did not take any action to rescue a patient or facilitate his/her condition. In particular, depression often results in the emergence of suicidal thoughts. In case the doctor was not informed of such change in the flow of the disorder or the patient was left unattended, the possibility of causality is rather high (Burton & Ormrod, 2011).
Thus, the approach of the RN must differ depending on the type of the disorder the patient is diagnosed with. In case of the physical illness that does not affect the judgment of a person, the RN must be primarily guided by the principle of autonomy in her actions. It is based on the respect for each patient and his/her decisions. The person can only be considered as a goal rather than a means of achieving it. The principle of autonomy involves such aspects of care as confidentiality of the patient, informed consent to medical intervention, joint planning, implementation of the plan of care, and the independent decision-making by the patient. On the other hand, in case of mental disease, when the person is often deprived of the autonomy, the RN’s approach must be based on the principle of charity, which involves sensitive and attentive care for the patient on the constant basis (Burton & Ormrod, 2011).
However, there are still similarities between the mentioned approaches as both of them are based on the provision of the equivalent care to all patients regardless of their status, position, and profession. Moreover, both these approaches require that the actions of the RN cause no harm to the patient (Burton & Ormrod, 2011).
The treatment of either diabetes or depression often requires the combined efforts of the interprofessional team of healthcare specialists. In particular, the treatment of diabetes requires the collaboration of endocrinologist (the primary specialist) and dietitian (the creation of a specific diet for the patient). Sometimes, the treatment requires the involvement of the nephrologist in case diabetes is accompanied by the chronic kidney disease and ophthalmologist if diabetes led to diabetic retinopathy (Munden & Foley, 2007). In case of depression, the involved professionals include therapist (the appointment of sedatives and light antidepressants) and psychotherapist (the identification of the painful prejudices and changing the patient’s attitude). In case the depression is severe, the team also involves psychiatrist and sometimes neurologist if depression is accompanied by a neurologic disorder such as Alzheimer’s disease (Beck & Alford, 2009).
The RN plays a supportive role during the treatment of both diseases by performing the following functions (Burton & Ormrod, 2011):
- Making the observation of the patient: overall mood in case of depression and heart rate and body weight in case of diabetes;
- Ensuring the timely and properly performance of medical prescriptions;
- Adhering to the strict diet (in case of diabetes);
- Providing the emotional support to the patient;
- Assisting the other healthcare specialists.
The treatment of both diabetes and depression requires the patient to adhere to a treatment regimen and undergo a sequence of therapeutic procedures. However, as was mentioned before, the incompetence of the patients and their families often disrupt the flow of treatment. As a result, it is necessary to implement certain measures to ensure the adherence to the regimen and the follow-up visits. In case of diabetes and depression, the patient is actively involved in the process of treatment. Thus, the measures should be as follows (Burton & Ormrod, 2011):
- The organization, conduction, and evaluation of individual and group training programs for patients;
- The implementation of the educational and patronage programs both during home visits and collaboration with primary healthcare providers;
- The development of educational programs for individuals who are in direct contact with patients (teachers and patronage nurses).
The efficiency of the work of interprofessional team caring for the patients diagnosed with diabetes or depression can be evaluated by determining its workload and the quality of care. The accuracy and reliability of evaluation can be improved by the integration of such factors as the severity of the condition of a patient, the nosology of the disease, the volume of diagnostic and therapeutic measures and their compliance to the medical and economic standards as well as the expert and advisory work of the team (Burton & Ormrod, 2011).
In addition, the RN evaluates the efficiency of the interprofessional team’s efforts. The primary way of carrying out this task is the assessment of the dynamics in the patient’s health since the RN is responsible for the control over the patient. The retrieved information can be used to make the necessary adjustments in the plan of care to ensure its efficiency. In particular, in case of diabetes, the RN can monitor the changes in patient’s blood sugar level and body mass, making the suggestions on the necessity of changing the doses of insulin or the diet of a patient and consulting with the head of the interprofessional team about their feasibility. In case of depression, the RN may monitor the general condition of the patient, reporting any positive or negative dynamics to the psychiatrist as well as suggesting the additional treatment that involves either the intake of sedatives and antidepressants or non-drug-therapy (Burton & Ormrod, 2011).
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Thus, it is possible to conclude that despite all the differences between diabetes and depression, which are manifested not only in their nature, flow, and consequences but also in the approaches to their treatment, these diseases have much in common. The similarities include their negative effect on the lifestyle of the patient as well as their complex nature (i.e. the accompanying diseases), which stresses out the importance of collaboration between various healthcare specialists, including the RNs, during the process of treatment.