9 Out of 10 Physicians Feel Mood Disorders Negatively Impact Diabetes Care: QuantiaMD Study
69% of Physicians Say Mood Disorders Affect More Than a Quarter of their Diabetes Patients
Waltham, Mass. November 2, 2011 – A new study of over 5,000 clinicians by QuantiaMD, the largest mobile and online physician community, explores the top challenges in diabetes patient care. In the study, clinicians shed light on the major impact of mood disorders on patient motivation. Nearly 90% of clinicians indicate that mood disorders result in non-adherence to self-care instructions, while 69% believe mood disorders affect more than 25% of their diabetes patients. Also of note, study participants believe lack of patient motivation is a greater barrier to reaching critical care goals than lack of education.
1. I wasn't able to read the full press release, but did this study stratify between type 1 and type 2 diabetes? They are two different conditions.
2. In terms of "mood disorders" resulting in lack of compliance, did they ever consider that "mood disorders" may be a manifestation of fluctuating blood sugar levels? I think this is especially true among type 1s, who often experience HUGE fluctuations in blood sugar levels, the natural result when you try to operate your pancreas in manual mode.
3. Did anyone look at the reasons behind the "lack of patient motivation?" Did the study acknowledge how, at least for type 1, burnout is all too common because this disease NEVER GIVES YOU A FREAKING BREAK??? I have to wake up sometimes twice during the night to test my BGs because I was either two high or low before going to bed, and I'm scared of dying in my sleep. So, yeah, sometimes the next day, in my sleep-deprived state, I feel less-than-motivated.
I just hate how, with diabetes, so much about "control" is placed directly on the patient's shoulders. When "good control" isn't achieved, the question is so often, "Well, what is the patient doing wrong?" Not, "Gee, this is just a crappy disease."
I would think that T1 and T2 would be similar in "never giving you a break" and the potential for devastating consequences. I'd agree that it might be interesting to see if they differ but I sort of suspect that for what this is studying, the results would be very similar between the two types.
I sort of read it like they concluded that the rate of mood disorders was higher in PWD as the "straight" population exhibited what looks like around 4% of the population (2008 study) whereas PWD seem to be showing 25%? I totally don't get the report mentioning food and weight loss without referencing low carb studies. It would be interesting to get a group of volunteers, say if there were a community of people adopting lower carb lifestyles wholeheartedly (e.g. the Bernstein group here?) who could volunteer to help the medical industry do research?
I agree that the reasons behind patient motivation should be explored. I kind of suspect that I'm not a good example as I sort of "run the show" w/ the doc although she is always accomodating of my bestial demands for test strips and other Rx'es. I kind of get a sense that a lot of docs are either clueless or have given up on helping their patients deal with challenges, at least from stuff I've heard on boards and a few cases I've "run into" at work.
My initial reaction was annoyance with the term "mood disorders". I don't think being in a bad mood about something bad is a disorder. Grinning through crappy stuff... THAT'S disordered. I think that language implies that the "blue times" (read: sad, angry, rebellious, enraged, depressed...) we all sometimes experience are somehow pathological and strange, rather than totally logical responses to our situations. It made me feel misunderstood and judged by the very folks who treat me.
I think that may say more about the psychology industry's need to justify their existence with "classifications" and "disorders" as if it were something like "antlers" that you can see? I'm not saying I disagree but, in our office, about 90% of the people seem pretty cranky about 90% of the time which makes me wonder about them suggesting that only 4% of "straight" people have "mood disorders"? At the same time, a lot of people are afflicted with different varieties of problems of this nature and, given the self-management I've found necessary to practice (heh heh heh) with diabetes, it wouldn't suprise me that if you had some mood issue, it would negatively interface with diabetes.
I think you're onto something with the lower carb lifestyle study. My mood is always pretty great, unless I'm getting a toe cut off, because my low carb diet has worked to keep my blood sugar down. My cousins follow a diet from their doctors that (in my opinion) is guaranteed to fail. They are always down because they think they're not working hard enough, and their doctors are on their cases. They're given this drug and that one, and over the years their stories are more and more drugs, gaining weight (we're all T2), and their blood sugar just keeps getting worse.
For the last 2 months I've adopted the low carb type 1 diet made famous through Dr Bernstein, and I think it works. It's boring. It's incredibly boring and I've lost weight for what I can see is no other reason than I can't be bothered to eat as much when it's so dull, so long term, I'm not sure how long I can stick with it, but I do think it's an interesting tweak on the viewpoint of the norm.
Doctors are sometimes unrelenting and frankly, rather accusatory towards patients if they feel they're not trying hard enough, possibly losing sight of how relentless being diabetic is. It isn't a lack of interest in many cases, or being unhappy. It's a need to sometimes take a damned break, and then finding it hard to get back on that wagon once the break has been taken.
I've had some times when I've not been very on the ball, and like so many things human beings do, we somehow block it out for the sake of our own sanity.
When things don't work no matter what, it's easy to tune it out. Surely everyone does this? It doesn't make sense to flog a dead horse.
That's why I've been really into low carbing of late. I cleared it with my Endo, who was surprisingly understanding about me wanting to try it. I have good kidney function so why not, was his reply. Who'd have thought... It seemed to take away the complexities of the whole sliding scale mess that diabetes is and restores instead a degree of autonomy.
I'm looking forward to seeing how my A1C is after a few months of this, and also to see if my blood pressure and cholesterol has risen :D. Also it's given my CGM a considerable improvement in accuracy, ironically now my levels are more stable, so that too has been more enjoyable to use and therefore easier to maintain and stick to and with.
Going off on a tangent a bit there, but I suppose what I'm trying to say is, I have been given back some control that I haven't felt available to me in some time, and because it's calmed that inferno of doubt and unexplained nonsense, and so yes my mood level has improved, and I suppose you could argue that I'm more likely to respond well to doctors orders because of this...But it's rather a stretch to apply the two and overlay them into some kind of psychological link.
Of course it's easier to stick with something that works and is easy.
Well, I'm not "officially" into the lifestyle, as I am a "werewolf" and pig out @ night. I cut back a lot during the day though and think that it amounts to an "easy button" that makes a challengiing disease much less work. I feel good having had that success and, when I come home and load up on carbs, it's in the evening, I load up on endorphins by working out and am able to be jolly about that too. Just my "seat of the pantsing" makes me think it would be a good thing and I find it a bit disturbing that the subject didn't really seem to be brought up in the study, except maybe as a hint at the that high carb causes 89% of the problems. To me, I have had some long term weight issues that are sort of "done" but it's 1) much easier and 2) w/ smaller "doses" of carbs during the day, I think that it's easier to spot drifting ratios and rates and keep them closely aligned. I will change rates or ratios if I see a number "drift" for 3 days but a lot of people seem to only change stuff when they see their doc every 3 or 6 months, maybe 12 months?
I haven't talked about this with my doctor much at all but it seems to work very well for me. A lot of people report that it works for them and ***anything*** that works that could be marketed welll enough to get 10% of 1 million people with diabetes happier would be 100,000 happy people that, in turn, could serve as a kernel for additional studies, etc. Then there could be "spin-offs" as "straight" people could benefit from our "Right Stuff"? Diet plans are expensive and seem to be hard to study but it seems like it would be of value to explore more aggressively.
"1) much easier and 2) w/ smaller "doses" of carbs during the day, I think that it's easier to spot drifting ratios and rates and keep them closely aligned. I will change rates or ratios if I see a number "drift" for 3 days but a lot of people seem to only change stuff when they see their doc every 3 or 6 months, maybe 12 months?"
Bingo.
You just turned your complicated F1 engine into a 4 stroke and you can now enjoy it and work on it at home.
It almost seems like it would be more 'humane' to start out diabetics on this ultimately dull and lack luster diet and then have them tweak it and add to it to their own taste, just as you describe here where you keep it simple during the day and then get more complicated with your stomach when you have the time to deal with it :D
Rather than, well, just pretend all is fine and it's business as usual and we'll figure out the problems when they arrive. For many they never learn why the problems are there at all and so they're micro-managed and feel like they're these weak minded mortal fools who dare cross their doctors orders for the sake of a small mercy happiness like some delicious fast acting carbs.
Without a contrast to compare with and learn from. It's just all degrees of wrong when you go to the Docs.
I like the F1 vs. 4 banger analogy! I would change my name to 4 banger if I didn't have a lovely page and lifestyle developed here @ Tu already.
What I notice is that if I'm even a little bit "off", my numbers will blow up all over the place. I had a sort of freaky drift in late September, early October, right before I ran my first marathon DP just came out of nowhere. I've always had a little basal bump but I was 200, 250, etc. every morning! Turn it up a shade, *still 200+* and was sort of freaking out but just said "well, something drifted..." and I turned it up a few more clicks and it settled in a shade over 50% more than my standard rate for a couple of hours. And it's totally gone away since the race October 9/ surgery October 21. I don't know why, it was such a *blip* on my radar that I wouldn't even bother the doctor with it and, if I had, I probably would either have had the nurse email me and tell me to turn it up or gotten an appointment and brought in a bunch of already corrected numbers in a week.
I dont think that the diet is inherently lackluster though. I like hot sauce a lot and will just fry frozen veggies in some sriracha sauce, or salsa or throw in some garlic and pepper or cinnamon, all kinds of stuff. I love eggs so breakfast is really yummy too. Lunch is at work and I'm too freaking busy to blow an hour driving around to eat crap so 17G of carb 1/2 sandwich that I inhale in about 3 bites does the job. That's like 2/3 of 5 days/ week so it sort of "banks" a lot of decent lines with very little actual work on my part, a nudge here a walk back and forth to the fax machine there and things are pretty decent. It has been good to get in the habit of running too as I like that enough that I work hard to make sure that my BG doesn't $%@! up my good weather days or days I don't have other stuff going on. And, of course, it helps to buzz off the werewolf when the moon comes out *HOWWWL*
I definitely got into a 'bad mood' after reading that. I really disagree with their conclusions. It made me think of the following analogy.
Parent asks kid - did you finish your homework ?. You know you might be held back a grade if you don't. Kid says 'No, I wasn't able to complete it'. Parent thinks 'you have a mood disorder and are non-compliant'.
I found the following a while back, and agree with it much more than the conclusions of the study
It might be me when I say it's dull. I love carbs. I've been really hardcoring this bernstein thing and as such, go with 6 carbs for breakfast, and then 12 for lunch and 12 for dinner, so even things like hot sauce have to be used really sparingly. I'm generally getting my carbs from wasa crackers, and eating ungodly amounts of eggs. Oddly it somehow seems to work. I don't feel sleepy after eating, ever.
The oddest thing happens too. It makes a huge steak taste and feel like you just ate a salad :D
Just as though I was on a calorie restricted diet and tried to feel happy with a salad.
It's so incredibly unsatisfying without that full spectrum of food. I've lost 15 pounds so far so I guess I shouldn't complain. That said if I keep losing weight this fast I'll have to rethink things. I don't have THAT much to lose.
I'm just super excited to rethink everything. When I last tried this is was about 8 years ago and I didn't have my continuous glucose monitor to back up the findings. The findings that it works. It isn't perfect, and I've got some wrinkles to iron out, but even the highs on such a low carb diet are very unspectacular and float in the early 200's rather than that horrific explosive thing where you're at 300 and scratching your head as to why.
That's a huge limitation of mental health striving for legitimacy through classification and "standards". Instead of blowing $5-10K on psychologists I spent a couple grand on Tae Kwon Do classes and another grand on a pump and it worked ok. I guess I could have gotten the pump without the TKD but there was a push there to improve myself and it seems to have worked out ok for me, both mentally and physically. Although it inspired me to get a tattoo I'd fancied for *years*...
MyBustedPancreas, look at it this way. At least you're not a Type 2 diabetic having T1s constantly imply how lucky you are not to have the real diabetes. That's really depressing. Thanks for sharing.
I had a discussion with my care team around this a few months ago. I do think that diabetes management is largely behavioral in nature, it also breads depression and anxiety I think.
In the UK the behavioral elements are largely ignored, depressed, unmotivated people, facing economic pressures and difficult life circumstances are going to have a very hard struggle with the disease.
I think this side of treatment should be given more focus.
They always ask me and I'm like "nah, I'm fine" as I sort of presume that if I said "yes, in fact, I'm bummed out and it's cold out and I've been listening to Joy Division a lot..." they'd either 1) rx me something right out of the gate or 2) refer me to someone who'd rx something. Not that I'm notally opposed to "happy pills" but I would very likely research it and try to get the more recreationally amusing "happy pills" which is probably not very healthy, so I stick with amusing myself which works a lot of the time? Whether it would work enough to pass the scrutiny of a psychologist, I'm not sure but, as long as I don't talk to them, I'll be fine?
You got that 100 percent correct, busted pancreas. I am the mom of a teen diagnosed a year ago, and I think many people simply do not understand that this disease gives the patient no "break" (ever). Even the doctors can't seem to realize what kind of cloud people have to live under, knowing one mistake could be fatal. It is a heavy burden, and I think feeling that burden is reasonable too, and sometimes it might not even be a matter of having a "mood disorder" -- sometimes it is just honesty about the situation (that makes us feel crappy about it). Most of the time we manage to push these ideas out of our head, but let's be honest, t1d is a terrible disease, and we need a CURE, and the sooner the better.
