Addressing the Psychological Impact of Diabetes

Innovations in Diabetes & Metabolic Care | Spring 2025

According to 2024 data from the International Diabetes Federation, living with diabetes mellitus impacts the emotional well-being of three in four people.

Betul Hatipoglu, MD

“Worldwide, almost 77 percent of individuals living with diabetes experience anxiety, depression or other mental health conditions related to their chronic disease,” says Betul Hatipoglu, MD, Director of the University Hospitals Diabetes & Metabolic Care Center. “The Centers for Disease Control and Prevention [CDC] numbers show that people with diabetes are two to three times more likely to have depression, placing them at much higher risk than someone without diabetes.”

Dr. Hatipoglu adds that only about half of the emotional and psychological challenges faced by individuals living with diabetes are diagnosed and treated.

Team members within the UH Diabetes & Metabolic Care Center are committed to offering comprehensive, holistic care, including screening and services that address the mental health of their patients. “We have to see the entire picture of what it is to be human,” Dr. Hatipoglu says. “As we built our program, it was obvious to me that we could not provide a high level of care without integrating psychological services within our department.”

In 2024, the center welcomed Karen Tenreiro, PsyD, to its multidisciplinary team. “When patients express to one of the diabetes providers that they are experiencing some distress, feeling sad, worried or depressed, they can accept a referral offer,” Dr. Tenreiro says. “My role is to provide extra support from within the department, and I can handle concerns they have outside of their medical condition, too.”

Diagnosed with type 1 diabetes at age 10, Dr. Tenreiro has a unique insight into the challenges her patients face. Often, patients are encouraged to make significant lifestyle and dietary changes that can be difficult to maintain. “Diabetes requires a tremendous amount of self-management,” she says. “There are medications and technologies that help with many aspects, but people often have to cope with managing complicated interfaces to keep their blood sugars at the right level.”

A dynamic psychotherapist, Dr. Tenreiro begins by helping patients normalize what they are experiencing. “What I find is that people need to feel they are understood,” she says. “I try to help them recognize that their feelings are pretty common and that taking care of themselves can result in feeling better.”

Acknowledging the bidirectional relationship between diabetes management and mental health is at the heart of Dr. Hatipoglu’s philosophy. “As I saw patients, I realized that there are areas of medicine I am not fully equipped to treat,” she says. “In diabetes, each patient’s mindset has a huge impact on the success of my interventions—thinking we can achieve glucose control by writing a prescription and giving patients a list of DOs and DON’Ts is naïve.”

Questionnaires Aid in Identifying Anxiety and Depression

While Dr. Hatipoglu cautions that patients can become overwhelmed by too many questionnaires, she finds that they serve an important role as initial mental health screenings to ensure patients are not overlooked. “I think the easiest to implement into practice is the Patient Health Questionnaire-9 to get a baseline of how a person has been feeling over the past couple of weeks,” she says. “We are also trying to do the diabetes distress scale, the DDS17, which looks at emotional burden related to medications and treatment plans.” Information collected from these tools can help practitioners bring up concerns during appointments.

Making a Difference in Year One

“Already, I have patients who tell me that they wish they had the skills Dr. Tenreiro is helping them develop years earlier,” Dr. Hatipoglu says. “It is very powerful to give people the tools to reduce the load they have been carrying.”

Dr. Hatipoglu also hopes to remind health care providers to remember their own mental health. “In the busyness of taking care of our patients, we need to be reminded to take care of ourselves as well.”

For more information, contact Betul Hatipoglu, MD, at Betul.Hatipoglu@UHhospitals.org.

Contributing Experts:
Betul Hatipoglu, MD
Director
University Hospitals Diabetes & Metabolic Care Center
Vice Chair, UH System Clinical Affairs
Mary B. Lee Chair in Adult Endocrinology
University Hospitals Cleveland Medical Center
Professor
Case Western Reserve University School of Medicine

Karen Tenreiro, PsyD
Psychologist
University Hospitals Diabetes & Metabolic Care Center