Diabetes and Mental Health: A Comprehensive Review
François Pouwer, Dominic Ehrmann, Ragnhild Bjarkøy Strandberg, Khalida Ismail, Jori Aalders, Femke Rutters, Maartje de Wit, Jane Speight, Marjolein Iversen, Richard I G Holt
Diabetes and mental health. Lancet Diabetes Endocrinol. 2026;14:337–355. Epub 2026 Feb 20.
Mental health problems are common among people with diabetes, yet they remain underrecognised and undertreated in clinical practice. The demands of diabetes self-management are emotionally taxing, and the unpredictability of blood glucose levels can disrupt daily life, sleep, work, and relationships. At the same time, mental health problems can impair self-care and contribute to worse diabetes outcomes — a bi-directional relationship that has been documented for decades but still insufficiently addressed in routine care.
This comprehensive review, co-authored by Diabeter Center Amsterdam/Amsterdam UMC researcher Maartje de Wit, synthesises the current evidence on five mental health problems commonly affecting adults with type 1, type 2, and gestational diabetes: fear of hypoglycaemia, diabetes distress, depression, disordered eating behaviours, and sleep disorders. For each condition, the authors address prevalence, associations with clinical outcomes, underlying biological and behavioural mechanisms, and the evidence base for interventions.
Key POINTS:
- Mental health problems are highly prevalent: Fear of hypoglycaemia affects up to 56% of people with diabetes, diabetes distress around 20–45%, depression approximately 22% in type 1 and 19% in type 2 diabetes, and sleep disorders more than half. Many of these problems are bi-directionally linked to diabetes itself.
- Clinical consequences are serious: Mental health problems are consistently associated with suboptimal glycaemic control, reduced quality of life, higher risk of diabetes complications, and — in the case of depression and diabetes distress — increased mortality.
- Gestational diabetes is understudied: Data on mental health in gestational diabetes remain scarce across all five conditions, and validated tools such as a gestational diabetes-specific distress questionnaire do not yet exist.
- Effective interventions exist, but long-term evidence is limited: Cognitive behavioural therapy, mindfulness-based approaches, stepped care, and diabetes technologies such as CGM and automated insulin delivery systems have all demonstrated short-term benefits. However, their effects on long-term glycaemic outcomes and complications remain unclear, and larger trials are needed.
- Recognition in clinical practice is poor: In Dutch outpatient settings, elevated depression or diabetes distress was recognised by diabetes specialist nurses in only 20–29% of cases. Routine, validated screening is recommended by both the ADA and EASD guidelines but is not yet standard practice.
- Digital and e-health solutions show promise: Internet-based and app-delivered interventions can reduce distress and depression, particularly in resource-limited settings, though cultural adaptation and implementation science are needed to realise their full potential.
The authors call for action at all levels — from individual healthcare professionals to health systems and policymakers — to integrate mental health support as a routine component of diabetes care. They emphasise the need for multidisciplinary teams that include clinical psychologists, and for training diabetes professionals in how to initiate and support conversations about emotional wellbeing.
Concluding, the authors state
"High quality diabetes care should be tailored to the needs of the individual and therefore, diabetes care must also entail precision mental health care." -
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