It was badly predisposed.Prepared to find Peros.To defend against the questioning of the doctor when he told him that he had known that he was diabetic and not, he had not treated himself.Yes, I knew what the disease was.That he didn't have to tell him anything, that he had seen the effects on his father.He was there to comply with the derivation, because they had warned him that he should be controlled to turn on the graft made in his hand.I would listen a little, refute the same and return home.
But the Autobicot disarmed in the air barely entered the office.Emotions played a bad pass.In his plans it was not planned to break.Nor that the doctor did not judge him, nor to turn to a psychologist to contain him between them.The day I was going to change, it changed everything: it began to be treated for diabetes and depression.
The combo presented by Carlos Alberto Rodríguez is not exceptional.In Argentina, more than one in 10 people with type 2 diabetes also suffer depression (11.8%), according to the results of an international investigation presented in the last Congress of the European Association for the study of diabetes.It is a more than considerable figure if one considers that the prevalence of the mood disorder within this group doubles to that registered in the general population (5%, according to the World Health Organization).
"The investigation showed that the prognosis of diabetes and depression in terms of gravity of the disease, complications, resistance to treatment and mortality is worse for any of the diseases when they are comorbid (occur together) than when they occur separately,"Affirms the epidemiologist Catherine Lloyd, from the United Kingdom Open University, who led the International Study of Prevalence and Treatment (Interpret-DD, for which 15 countries participated and in which Argentina contributed the only sample ofSouth America.3000 patients of both sexes were evaluated in total, with an average age of 54 years and 9 years of diabetes.
They were examined by teams composed of diabetologists and psychologists.They were asked to complete questionnaires, interviews were conducted, and their medical records were used.The results showed wide differences between countries with depression percentages between 1 and 30% (see table).11.8% of Argentina places it within the third with higher rates.
How is it?
“The diabetic goes to the office and the only thing that speaks is diabetes.And the diabetologist of the only thing that speaks to him is diabetes, but he never asks how he is in mood.If I asked him, we would find twice the depression in patients with diabetes, ”says Adriana Álvarez, medical of the Italian hospital endocrinology.It is estimated that for each person with diagnostic diabetes with depression there is another in the same condition but without knowing it.“The fact that it is subdiagnosed implies that it is subtracted.And depression increases the risk of cardiovascular disease and morbidity and mortality.That is, having depression increases the risk of heart disease and being diabetic, much more. ”
Álvarez studied this complex relationship almost 10 years ago and was in charge of leading the local leg of international research with the psychologist Mónica Guinzbourg of Braude, which coordinates the psychodiagnosis team of the Italian psychiatry service.Although it does not exist as a formal section, both carry out the Psychodiabetology area of the institution, also integrated by the psychiatrist José Faccioli.Together they treat patients and investigate.“In Europe and the United States where much importance is given to howChronic diseases impact on the quality of life is a very common model.Here is novel, ”says Álvarez.
It was three who contained Carlos.Today's, at 54, is very different from the one broken in the office three years ago.He had spent a month hospital for a serious motorcycle accident that almost leaves him without a hand."I suspect I fell asleep," he speculates.He doesn't remember it.Nor does he remember how he got home every weekend during those times.Alcohol and drugs were his resources to evade depression, a disease that even led him to abandon a job as an administrative employee.
a complex relationship
“Not necessarily every depressed patient will end up having diabetes and neither will being diabetic automatically predispose to the patient suffering from depression.For this association to occur, more factors have to intervene.It is known that anxiety and depression constitute spontaneous and typical responses of individuals to different experiences and situations of life.The problem is generated when by intensity and duration these responses become fixed and influence affecting the daily routine.This is where the expert's opinion is needed to evaluate them and suggest different therapeutic options to contribute to their best evolution, ”explains Braude.
A wide meta -analysis carried out in 2008 on works produced since 1950 concluded that depression increased the risk of diabetes by 60%.Conversely, the association was weaker, but the researchers clarify that the phenomenon had been little investigated and that it was needed to deepen the study of that link.
That was the objective of the work of Argentina participated with 135 volunteers."In a study of these dimensions, what you are looking for is to see what the risk factor was for so many patients to make depression," explains Álvarez and continues.One was the female sex, but it is already known that depression is more common in women and that was replicated in the diabetic population.The strongest thing is to have had in the past some episode of depression.The personal history of having had some episode of depression does so, once diabetes appears, more vulnerable to developing depression. ”
The use of insulin is also associated with a higher level of depression.Is that the fact that metformin (a pill) and diet no longer reach to control blood glucose levels, speaks of evolution of the disease.And the evolution of the disease contemplates the appearance of complications such as retinopathies, cardiovascular problems and nephropathies, among others.“The patient thinks I can be blind, I can go to dialysis, they can cut a foot.It is not something that can be indifferent.The axis of diabetes is that you go to exercise and eat healthy: a person who is depressed cannot get out of bed.He will not exercise, eat junk food, the first thing he finds in the refrigerator.It is a vicious circle, ”says Álvarez, who is also an academic coordinator of the Italian diabetes sector.
One in ten Argentines with diabetes suffers depression
Carlos complies with his weekly visits to the psychologist.And once a month he goes to the diabetologist and the psychiatrist.(David Fernández)
“The treatment demands constancy.When you are depressed, you don't feel like anything.You don't care about anything, ”coincides Carlos.In his case, the history of the depression was.In 2007, a major depression picture had been diagnosed.The invoice arrived after years of suppressing what he had lived aboard the Belgrano General Cruise in the Malvinas War being a kid.He was in treatment for a year, but he fell again.
The accident was the trigger that motivated thechange.He went through 13 surgeries in a month to save his hand.With the help of the specialists he left alcohol and drugs (he still could not against the cigarette), he meets a low sugars and carbohydrate diet, he takes the medication and is injected insulin in the morning and night.And a month ago he started walking an hour per day ("I make it happy, not forced").The habit of exercise was the last to adopt."I take my time," he admits with a soft and kind voice.A month ago I asked for a medical apt to enroll in the gym.I still didn't score.But I'll do it. ”Once a week he goes to the psychologist and fulfills Rajataba with his monthly visits to the diabetologist and the psychiatrist.For professionals who attend it is an example.Also for his family (his wife and his daughters, 21 and 24 years old), who accompanies him and supports him.
Braude says: “Patients suffering from diabetes are not only affected by the inconveniences that the disease can brought to it, but they can also feel emotionally exceeded by the care it demands (medical indications, studies and treatments).While having to learn to take care of yourself implies one more work and can sometimes generate anger or stress, the power cope with a good attitude and predisposition The problem is an element that favors good evolution.People are much more than the disease they suffer and have resources to face and solve the problems that diabetes care can demand.There are even people who, in the face of these circumstances, discover in themselves favorable aspects that they did not know before.Being able to have good relationships of affection, family, friendship and work, favor feeling care and being able to take care of. ”
What to do
One of the findings of the recent study - whose results will be published in the prestigious Jama magazine, the Argentine researchers advanced - is that among people with diabetes, the registered diagnosis of depression and medication or therapy is extremely poor or non -existent.In a Medscape article, says Lloyd, “the improvement in the identification of depression and other mental disorders and the guarantee that those affected will have access to treatments can lead to a better quality of life, better management of diabetes and better resultsclinical ”.
The main recommendation is aimed at professionals who attend to these patients.In addition to taking the pressure, the pulse of the feet and filling the thousands of forms so that they can access medication and supplies, at least once a year they must ask how they are in mind.And, if necessary, derive them.Yes, it is not easy in a system that increasingly shortens the consultation time that often forces us to attend the urgent and set aside the important.“We have to educate patients.Just as we teach you what are the symptoms of hypoglycemia, we must teach them what are the symptoms of depression.If they have them, they have to hit the office door and say 'Doctor, I need treatment', ”suggests Álvarez, who also coordinates the working group of psychosocial aspects of the Latin American Diabetes Association.
The specialists in asking for help are usually women.But not for them, but for their partners ("I can't get it out of the chair, it's all day with remote control")."Families can alert, but not directly influence, it is the patient who must take the reins."
Carlos agrees: “The main thing is to mentalize one.Be convinced of what one is going to do.If not, everyone can talk to you, advise you, but you will not change.And then you have to ask for professional help.To me the diabetologist, psychologist and psychiatrist was what served me. ”
There is a powerful and effective weapon againstTwo diseases: physical activity.“Walking 30 minutes per day improves mood and glucose levels.And being well in mood helps to fulfill the diet.In addition, chronic physical activity improves endorphins, hormones that give you pleasure.And serotonin, which is what is diminished in depressed.In addition, it prevents Alzheimer's, another disease that has twice as much prevalence in diabetics.Simply put on the shoes and go for a walk every day.Too bad they don't sell it in pharmacies, ”laments the doctor.
Álvarez underlines an issue that he considers central: the person must understand that he has no blame to feel bad.“At a certain age, and when one has several Commerities, the impact on mood can be a consequence of biological disease.It has treatment and can be cured.Diabetes is not cured.The depression does. ”
some keys
In Argentina, 1 in 10 adults have diabetes.90% suffer from type 2 (they are resistant to insulin or produce it inadequately).
The symptoms of depression cover: irritable or low mood, sleep disorders, changes in appetite, tiredness or lack of energy, sentimentals of uselessness and guilt, difficulty in concentrating, inactivity and withdrawal, feelings of hopelessness and abandonment, thoughtsof death, loss of pleasure.