Type 1 diabetes, and the second chart nobody hands you

People with type 1 diabetes keep more records than almost anyone: glucose readings, insulin doses, carbohydrates, the occasional 3 a.m. alarm. A research letter in the Annals of Internal Medicine, published online on 20 October and reported on Tuesday, suggests one more line belongs in the log¹.

Tianyu Cao of the Johns Hopkins Bloomberg School of Public Health and colleagues used the US National Health Interview Survey, 58,106 adults in all, including 326 with type 1 diabetes and 5,802 with type 2¹. The weighted shares were 0.6% and 8.9% of the adult population¹.

The gap is plain. Moderate or severe depressive symptoms were reported by 17.1% of adults with type 1 diabetes, 12.4% with type 2 and 6.6% without diabetes¹. For moderate or severe symptoms of generalised anxiety disorder the figures were 16.2%, 8.7% and 6.1%¹. Desk arithmetic: in this survey, people with type 1 diabetes reported depressive symptoms at about two and a half times the rate of people without diabetes, and anxiety symptoms at about two and a half times as well. Within the type 1 group, rates were highest among women, people with less than a high-school education and those under 65¹.

Two cautions. A survey measures symptoms, not diagnoses, and 326 people is a modest group for slicing into subgroups. Neither caution makes the gap go away.

The authors’ conclusion is refreshingly operational: “Better mental health screening, especially in high-risk populations, is essential for improving diabetes management and quality of life”¹. That is not a call for a campaign. It is a call for a questionnaire in the waiting room of a clinic that already exists. If you live with type 1 diabetes and the low days have stopped being about glucose, that is a legitimate thing to raise at your next appointment.