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Evaluate for depression (see Standard 4)
There is a substantial increase in the prevalence of depression among people with diabetes as compared to the general adult population (Anderson 2001). Depression impacts the ability of a person with diabetes to achieve blood glucose control, which in turn impacts the rate of development of diabetes complications (de Groot 2001; Lustman 2001).
Identification and management of depression is an important aspect of diabetes care. Self-administered or professionally administered instruments, such as PHQ-9, are useful adjuncts to the clinical interview in the identification of depression. The ICSI Major Depression in Adults in Primary Care guideline provides more suggestions for the identification and management of depression. Intervention studies have demonstrated that when depression is treated, both quality of life and glycaemic control improve. Counselling may be effective, especially among those who are having difficulty adjusting to the diagnosis of diabetes or are having difficulty living with diabetes. Pharmacotherapy for depression is also effective.
Evaluate for obstructive sleep apnoea (OSA)
Sleep apnoea is a prevalent condition in obese patients with type 2 diabetes and is associated with significant comorbidities including hypertension, cardiovascular disease and insulin resistance. Consider referral of symptomatic patients for sleep evaluation.
Clinicians should be cognisant of potential obstructive sleep apnoea, especially among obese patients (ICSI, pp 17–18).
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