The Screening and Management of Comorbid Depression in Type 1 Diabetes for Improved Compliance

Advanced practice and primary care providers are increasingly managing the ever-growing population of patients with diabetes—with a 2016 American Academy of Family Physicians (AAFP) study from the Medical Expenditures Panel Survey (MEPS) finding that a full 48 percent of medical encounters for the subset of patients with diabetes but no other chronic health conditions were in fact managed by general clinicians.1 Patients with diabetes face chronic, severe sequelae of their disease, often suffering comorbid conditions as well, including mental health diagnoses. Physician assistants (PAs) are likely to face increased diabetic patient caseloads—frequently including patients with unmet mental healthcare needs, and a review of the current literature on management is warranted in order to optimize care. Clinicians are typically familiar with the general course and management of the more prevalent type 2 diabetes. Type 1 diabetes, specifically, is an autoimmune condition typically diagnosed in childhood and which, unlike some forms and stages of type 2 diabetes, requires immediate and lifelong insulin therapy, with use of lancets, meters, and injections of insulin every few hours. Diet and exercise are first line preventative treatments for new onset type 2 diabetes, and oral medications can then be initiated to stall progression to insulin-dependent type 2 in general practice. Type 1 diabetics, however, typically do not have clinically actionable preventative therapeutic and lifestyle modification windows. Although autoimmune cascade-halting preventative drug target studies are promising,2,3,4 they are currently in the nascent stages of development, and no current diet nor oral medication reliably prevents type 1 in humans. For these reasons, clinicians in both endocrinology specialties and in the primary care setting need data on best practice guidelines as well as to be apprised of known comorbidities their patients are likely to face, from what is an unpreventable diagnosis in the case of type 1, and often a difficult to prevent diagnosis in type 2