Roche's New Diabetes State of Mind Survey with Matt Jewett, Senior Vice President and General Manager, Diabetes Care US

Who were the respondents of the survey and what did it focus on?

People with diabetes experienced a disproportionately high rate of mental health problems, including depression, anxiety, and eating disorders. So, we recently asked through an online survey that we've named the Diabetes State of Mind. If adults in the US, including people with diabetes, were aware of that connection between diabetes and mental health. And while there's a wealth of published data on the connection, we wondered how much of that was really known outside of the medical community. And that survey reported that just half of people or about over half of people were surprised that diabetes and mental health are connected. So, it reveals an awareness void that we need to fill. 52% of the people with diabetes that responded to the survey said their state of mind is always or often tired. 43% said stressed, 32% said burden, and often feeling anxious, frustrated, hopeless and angry. We also reported by a significant number of respondents. Additionally, the survey revealed that the top issues that impact the mental well-being of people with diabetes range from their ability to manage diet and exercise at 49%, attaining blood glucose goals at 33%, big life transitions at 32%, and the ability to speak freely about diabetes and the needs of diabetes management at work at 20%. So, with almost 1/3 of people with diabetes, affected by mental health conditions, and nearly half of those going undetected. More awareness and more support are needed to reduce the barriers to seeking help. Affordability and access to therapy were cited as barriers by 45% and 35% respectively of those respondents; but respondents also cited embarrassment, judgment from family, friends and employers, and the stigma associated with seeking professional treatment as additional barriers.

Where are diabetes patients looking for the most support?

They're busy. People with diabetes, like everyone else, are busy. They've got careers, family, friends, and responsibilities. And although diabetes right now is a full time job requiring attention every day—they don't want to think about it all day. So, they want to reduce frustration and anxiety related to this chronic condition into their lives. What we've found makes a difference and alleviates some of the burden of diabetes management, are tools they can trust that are accessible and affordable; help them track their blood glucose levels and provide a concise, easy to read easy to use information, helping them feel more in control and not alone. So, as a global leader in diabetes management, we at Roche are committed to driving sustainable, patient centric solutions to help improve the lives of people with diabetes.

How can patients take control of their diabetes and at the same time improve their mental health? How many of the factors are controllable?

It's all related. So, it's important to address mental health issues, including diabetes distress, when a person feels frustrated or overwhelmed by diabetes. So according to CDC, untreated mental health issues can make diabetes worse, and problems with diabetes can make mental health issues worse. But fortunately, if one gets better, the other tends to get better too. So, the link between them is important. Mental health issues are a secondary complication of diabetes, and there is a need to create more understanding, so that people with diabetes feel comfortable asking for help. The more conversation there is, the easier it'll be for people with diabetes to tell their family, their friends, their health care providers, their employees if they're not okay, and get the help they need. There are resources available for people with diabetes who are struggling with anxiety and depression or need mental health support. We've listed some of these in the mental well-being section of our website, accu-chek.com/mental-wellness, and they include resources from the American Diabetes Association, the CDC, and the National Alliance on mental illness. So, the CDC estimates that people with diabetes are two to three times more likely to have depression than people without diabetes. And unfortunately, depression may negatively impact their diabetes control and place those affected are at a higher risk of developing complications such as eye, kidney, and heart disease. The stress of living everyday with diabetes and trying to keep it in check can actually make it more difficult to control the diabetes. Stress releases hormones causing more pronounced fluctuations in blood sugar, making it even harder to keep the target blood glucose levels in range. And more awareness of triggers of emotional stress can provide earlier recognition of the need to take action. Sometimes this is just as simple as feeling safe, talking about this with a family member or friends, sometimes it's voicing the need for help to the health care provider.

Tell me about the correlation between depression and diabetes.

The CDC estimates that people with diabetes are two to three times more likely to have depression than people without diabetes.¹ Unfortunately, depression may negatively impact diabetes control and place those affected at higher risk of developing complications such as eye, kidney and heart disease.²

The stress of living every day with diabetes and trying to keep it in check can actually make diabetes more difficult to control — stress releases hormones, causing more pronounced fluctuations in blood sugar, making it even harder to keep levels in the target range.² More awareness of triggers of emotional stress can provide earlier recognition of the need to take action. Sometimes this is as simple as feeling safe talking about this with family and friends. Sometimes, it’s voicing the need for help to their healthcare provider.

Why do you think there’s still such a significant portion of the population that is so afraid of seeking help?

The stigma is part of it. But from our survey results, there's so many pieces. Our survey revealed several barriers for people with diabetes to seek mental health. Sort of in order: to include affordability, access to care, embarrassment, judgment from family, friends, employers, and then that broader bucket that you mentioned that the fear of stigma associated with seeking professional help.

Where do you think this space will be in five years?

As you know, the number of people living with diabetes just keeps growing, and therefore high quality and cost effective for a sustainable healthcare system therapy management is very, very much needed. So, we'll see continued technological advancements and the adoption of continuous glucose monitoring to support diabetes management, CGM can enable pathways to more optimal therapy adoption, particularly but absolutely not limited to automated insulin delivery. And then finally, I certainly expect that there will be continued access to incredible based therapies like GLP ones, for treating obesity and patients with and without type two diabetes. Clearly obesity is one of the biggest health challenges in the world with extensive comorbidities including type two diabetes, but also including cardiovascular disease, fatty liver, chronic kidney diseases and more. So, for now, diabetes is still a 24/7 disease that feels like a full-time job to manage. But we're working hard every day to develop more personalized solutions that help alleviate the burden, and help people with diabetes live there live their lives really to the fullest.

Resources

1. CDC Diabetes and Mental Health
   https://www.cdc.gov/diabetes/managing/mental-health.html#:~:text=Depression:%20More%20Than%20Just%20a%20Bad%20Mood&text=People%20with%20diabetes%20are%202,both%E2%80%94is%20usually%20very%20effective
   
2. Hackett, R., Steptoe, A. Type 2 diabetes mellitus and psychological stress — a modifiable risk factor. Nat Rev Endocrinol 13, 547–560 (2017). https://doi.org/10.1038/nrendo.2017.64