Diabetes stigma and diet culture amplifies messaging which suggests diabetes requires mental vigilance, special food, and rigorous activity to add to the challenge. This means a disproportionately large number of people with diabetes are receiving messages implying diabetes is ‘their fault’ and unless they are perfect they have failed. The blame, shame, and stigma of diabetes is also part of the challenge because it touches the population who most likely are also already managing heart disease, stroke, kidney, urinary problems, and depression. Diabetes isn’t a single issue because it impacts those struggling financially, who have an existing mental illness, depression, chronic pain, or mobility issues.
Depression is a risk factor for diabetes and diabetes is a factor for causing depression. The symbiotic relationship is complicated and can be seen as an opportunity for the medical community to consider how messaging is targeting a more privileged population. Reflect for a moment and consider the impact having ‘just a touch” or “borderline” diabetes descriptions could have on your patients. Offered as a way to ease fears and worry, the unintended consequences minimize a person’s experiences which feels invalidating and fail to express how diabetes is tied to other conditions, including heart disease, hypertension, and risk of depression which, by the way, is increased by a factor of two in patients with diabetes. Studies have documented the interdependence of depression/diabetes as contributing to poor patient engagement, adherence to medication and dietary regimens, glycemic control, reduced quality of life, and of course, increased health expenditures. The expense of depression and diabetes was calculated in a 2016 study with the overall mean medical expenditures for patients with diabetes and no depression was $10,016, unrecognized depression was $15,155, asymptomatic depression was $16,134, and symptomatic depression was $20,105. This study looked narrowly at depression and didn’t factor in how the Social Determinants of Health (SDoH) have a similar symbiotic relationship with diabetes.
According to the National Institute of Drug Abuse, Substance abuse costs our Nation over $600 billion annually. The average cost for 1 full year of methadone maintenance treatment is approximately $4,700 per patient, whereas 1 full year of imprisonment costs approximately $24,000 per person. Every dollar invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft. When savings related to healthcare are included, total savings can exceed costs by a ratio of 12 to 1. Major savings to the individual and to society also stem from fewer interpersonal conflicts; greater workplace productivity; and fewer drug-related accidents, including overdoses and deaths.