In Chennai, diabetologist Dr V Mohan checks his patients’ mental health, while at her practice, psychiatrist Dr R Padmavati monitors blood sugar levels of her clients. Both doctors hope tackling one will help set the other right.“Diabetes can lead to depression. And depression can make diabetes worse. It is important to treat both together,” says Dr Mohan, director of Madras Diabetic Research Foundation. His centre has begun using the PHQ-9, a nine-question screening tool to identify depressive symptoms and assess severity. “We have counsellors; those with mild depression can benefit from counselling, and they do well,” he says.Chronic health conditions such as diabetes, cardiovascular disease and mental health conditions require attention to lifestyle factors such as diet, physical activity and adequate sleep, says Dr Padmavati. So her patients log in body weight, waist circumference, glucose levels and ECG results before consulting her. “Research shows people with schizophrenia die, on average, 15–20 years earlier than the general population. A contributing factor is inadequate identification and management of diabetes.” Certain psychiatric medications, she adds, can also increase the risk of diabetes.Schizophrenia Research Foundation (India) in Chennai, where Dr Padmavati serves as a consultant, has a virtual exercise programme to promote physical health among people with mental health conditions.At Chennai-based Voluntary Health Services, Dr Lakshmi Vijayakumar says the department of psychiatry, which she heads, works in tandem with the department of endocrinology. “Diabetes and depression have neurotransmitters in common such as serotonin and dopamine,” says Dr Lakshmi. “Insulin receptors in the brain help maintain healthy dopamine and serotonin levels, but when the cells become resistant to insulin, neurotransmitter signalling breaks down and disrupts emotional regulation and metabolic control.”Dr Mohan’s trial, published in JAMA and conducted at four centres across India, found that positive encouragement from care coordinators, dieticians and educators helped control diabetes and bring down depression scores. “We had to stop the intervention after a year. When we followed up with participants after the break, we found the effect had waned. It shows those with diabetes need constant emotional support.” MDRF, he says, has now started the ‘Friends forever’ support group for those with Type 1 diabetes and also conducts group sessions for those with type 2 diabetes.The Blue Circle Diabetes Foundation, a patient-led NGO for people living with diabetes and their caregivers, has a free Buddy Project helpline, which offers emotional support in several languages, including Tamil. “About 5% of diabetes care rests with the doctor; 95% depends on patients,” says founder Nupur Lalvani, who has Type 1 diabetes. They have received 3,000 buddy calls so far.“All our buddies have lived experience,” says Nupur, adding that she started the network because she feared managing the condition alone when she moved cities for work. Blue Circle now has chapters across the country, including regular coffee catch-ups in Chennai and Coimbatore that bring people with diabetes together.Arvind Ramaswamy, a Tamil-speaking buddy, now 51, was diagnosed with diabetes at 25. “There was no helpline at the time. At 25, diabetes can feel like a lifelong sentence,” he says. Today, Arvind speaks to callers facing similar fears, mostly people in their 20s newly diagnosed with diabetes. “Having someone to talk to helps. They want to be reminded they are not alone.”Research too shows that diabetes distress, the emotional stress, that comes with living with the condition is likely to affect one in three people with it (per a 2024 study in Clinical diabetes and Endocrinology).
