Type 1 Diabetes and Psychiatry

There is a consistent pattern of association of several psychiatric disorders and type 1 diabetes (T1D) including depression, anxiety, eating disorders, and personality disorders. The presumption is that most psychiatric morbidity is accrued from the psychological burden per se of T1D or that individuals with subclinical pre-existing mental health difficulties are tipped into an overt psychiatric diagnosis. Elements of the T1D regime, namely the acute focus on food and the energy it contains, as well as heightened requirements of self-control can predispose to eating disorders, while others find the unrelenting requirements profoundly depressing, leading to clinical depression. Others acquire diabetes-specific anxieties, such as fear of hypoglycaemia or preoccupation with long-term complications. Psychiatric disorders impact diabetes self-management and there is an established association with acute and long-term complications including increased mortality. An underlying mental health problem should be a primary differential in certain clinical scenarios. such as persistent high HbA1c (>80 mmol/mol IFCC), particularly with recurrent diabetic ketoacidosis (rDKA) and also those with recurrent severe hypoglycaemia. This is particularly important in rDKA where subsequent all-cause mortality is in excess of 15% and closely linked to mental health disorders. Early recognition of psychiatric disorders is therefore vital for prognosis for both physical and mental health and diabetes clinicians should routinely monitor for psychiatric disorders.