**Diabetes and mental health** Diabetes is a chronic disease that affects how the body converts food into energy. There are two main types of diabetes: type 1 and type 2. Type 1 diabetes is an autoimmune disease that causes your body to attack the cells in the pancreas that produce insulin. Insulin is a hormone that helps your body's cells use glucose for energy. Type 2 diabetes is the most common form of diabetes. This happens when your body becomes insulin resistant or doesn't produce enough insulin. People with diabetes are at increased risk of mental health problems, such as depression and anxiety. This is due to several factors, including: *Stress related to diabetes control: **Diabetes can be a complex disease and requires management. People with diabetes need to monitor their blood sugar regularly, take medication, and make changes to their diet and lifestyle. It can be stressful and overwhelming, especially for those newly diagnosed. * **Chronic disease burden: **Living with a chronic illness like diabetes can hurt mental health. People with diabetes may experience fatigue, pain, and other physical symptoms that can interfere with their daily lives. They may also worry about long-term complications of diabetes, such as heart disease, stroke, and kidney failure. * **Stigma related to diabetes: **Diabetes is a common disease but can still be stigmatized. People with diabetes may feel embarrassed or confused about their condition, which can lead to social isolation and depression. **Telemedicine and diabetes management** Telemedicine is the use of technology to provide medical services remotely. Telemedicine can be used to provide a variety of diabetes care services, including: * **Remote consultation with healthcare providers: **People with diabetes can use telemedicine to consult with doctors, nurses, and other healthcare providers without having to go to a clinic or hospital. This can be especially convenient for people who live in rural areas or who have difficulty getting around due to mobility issues. * **Diabetes education and support: **Telemedicine can be used to provide education and support to people with diabetes and their families. This may include information about blood sugar management, diet and exercise as well as preventing complications. * **Monitor blood sugar and other health data: **Telemedicine can be used to monitor blood sugar and other health data remotely. This can be done using wearable devices or smartphone applications. The data can then be shared with healthcare providers to help them manage their patients' diabetes. **Telemedicine and mental health** Telemedicine can also be used to provide mental health services to people with diabetes. #diabetestelecare For Any assistance Contact us on www.diabetestelecare.com

1. AMONG DIABETES
PATIENTS - A
COMPREHENSIVE
REVIEW"
"EXPLORING INNOVATIVE SOLUTIONS FOR DIABETES PATIENT CARE"
1
DR SANIA BASHIR
Consultant Diabetologist
CEO Diabetes Tele Care
www.diabetestelecare.com

2. INTRODUCTION
• In an era where healthcare is continually
evolving, we embark on a journey to explore
innovative solutions that bridge the critical gap
between diabetes management and mental
well-being.
• Diabetes, a chronic condition affecting millions
worldwide, not only poses physical health
challenges but also brings to the forefront the
profound impact on mental health.
2

3. DIABETES & PSYCHOLOGICAL BURDEN
• The psychological burden faced by individuals living with diabetes cannot be underestimated.
Depression, anxiety, and diabetes-related distress often intertwine with the daily struggles of
diabetes management, significantly affecting the quality of life of patients.
• Diabetics are at an increased risk of developing mental health problems, such as depression
and anxiety. This is due to the stress of managing a chronic condition, as well as the physical
and emotional effects of diabetes.
• mental health problems can make it difficult for diabetics to manage their condition effectively.
For example, diabetics with depression may be less likely to follow their treatment plan or take
their medications as prescribed. This can lead to complications from diabetes, such as heart
disease, stroke, and kidney failure.
•
3

4. DIABETES & PSYCHOLOGICAL BURDEN
• Depression: Depression can lead to fatigue, lack of motivation, and difficulty
concentrating. This can make it difficult for diabetics to follow their treatment plan,
such as eating a healthy diet, exercising regularly, and taking their medications as
prescribed.
• Anxiety: Anxiety can lead to stress, which can raise blood sugar levels. Anxiety
can also make it difficult for diabetics to manage their condition effectively, as they
may be too worried to eat, exercise, or take their medications.
• Eating disorders: Eating disorders, such as anorexia nervosa and bulimia
nervosa, can disrupt blood sugar control and lead to complications from diabetes.
4

5. PSYCHOLOGICAL DISORDER – A STIGMA
• It is important to note that the stigma associated with mental health problems in
Pakistan can prevent people from seeking help, even if they are struggling. This
means that the actual prevalence of psychological problems among diabetics in
Pakistan may be even higher than what is reported in the studies cited above.
5

6. A VICIOUS CIRCLE:
•
6

7. OBJECTIVE
• we aim to shed light on the remarkable potential of telemedicine as a
transformative force in reshaping the landscape of mental health support for those
navigating the complexities of diabetes. Through telemedicine, we unlock new
avenues for accessible, timely, and personalized care, offering hope and healing
to individuals on their journey toward balanced health.
7

8. MATERIAL & METHODS
• Sl
• This study included a total of 250 patients with
diabetes mellitus, aged between 21 and 79 years.
Patients were randomly assigned to either the
conventional face-to-face mode of treatment (n=125)
or the telemedicine mode of treatment (n=125).
8

9. SELECTION CRITERIA:
Inclusion criteria Exclusion criteria:
Patients with diabetes mellitus, aged
between 21 and 79 years
Patients with severe cognitive
impairment
Patients who were able to provide
informed consent
Patients with severe psychiatric
illness
Patients who were able to use the
telemedicine platform (if assigned to
the telemedicine group)
Patients who were unable to use the
telemedicine platform (if assigned to
the telemedicine group)
9

10. METHODOLOGY
• Patients were randomly assigned to either the conventional face-to-face mode of
treatment (n=125) or the telemedicine mode of treatment (n=125).
• Patients in the conventional face-to-face group received standard care from their
primary care physician or endocrinologist. Patients in the telemedicine group
received care from a healthcare provider remotely via video conferencing.
• All patients were assessed at baseline then 3 months after the initiation of
treatment and then 6 months later. The assessment included measures of blood
sugar control, mental health, and quality of life.
10

11. METHODOLOGY
Parameters used for assessment includes:
• Patient Health Questionnaire-9 (PHQ-9)
• HbA1c
• Blood Sugar tracking Records
11

12. DATA ANALYSIS:
• Data were analyzed using SPSS software. Chi-squared tests were used to
compare the two groups on demographic and clinical characteristics. Independent
t-tests were used to compare the two groups on the outcome measures at
baseline, 3 months and 6 months after the initiation of treatment.
12

13. RESULTS
0
2
4
6
8
10
12
14
16
18
20
0 1 2 3 4 5 6
Telemedicine Group
PHQ-9 Baseline PHQ-9 After Treatment
HbA1c Baseline HbA1c After Treatment
0
2
4
6
8
10
12
14
16
18
20
0 2 4 6
Usual Care Group
PHQ-9 Baseline
PHQ-9 After
Treatment
HbA1c Baseline
HbA1c After
Treatment
13

14. PHQ-9
SCORING
14

15. PHQ-9 SCORING SYSTEM
15

16. TELEMEDICINE BENEFITS
• Telemedicine offers numerous benefits for diabetes patients' mental health care.
• It enhances accessibility, allowing patients to receive care from the comfort of
their homes.
• Telemedicine reduces geographical barriers, enabling patients in remote areas to
access mental health support.
• It facilitates timely interventions and improves patient engagement, ultimately
leading to better mental health outcomes.
16

17. TECHNOLOGIES
• Telemedicine relies on various technologies such as video conferencing, mobile
apps, and remote monitoring devices.
• These technologies enable secure communication between healthcare providers
and patients.
• Video conferencing facilitates face-to-face interactions, while mobile apps assist
in remote monitoring and data collection.
17

18. DIABETES TELECARE-
18

19. VARIOUS RCTS
• a 2018 study published in the Journal of the Pakistan Medical Association found
that the prevalence of depression among diabetics in Pakistan was 28.1%, which
is significantly higher than the prevalence of depression in the general population
(10%).
• Another study, published in the Pakistan Journal of Medical Sciences in 2020,
found that the prevalence of anxiety among diabetics in Pakistan was 35.2%.
19

20. CASES:
• Case Study 1: Improved Mental Health and HbA1c Control
• Patient: Jane, a 50-year-old woman with type 2 diabetes
• Scenario: Jane had been struggling with depression (PHQ-9 score of 12) and
high HbA1c levels (8.5%). She enrolled in a telemedicine program that offered
remote counseling and diabetes management.
• Outcome: After three months of regular teletherapy sessions and virtual
consultations with a diabetes educator, Jane's PHQ-9 score decreased to 5
(indicating improved mental health), and her HbA1c dropped to 7.0% (indicating
better diabetes control).
20

21. CASES
• Case Study 3: Remote Monitoring for Better Outcomes
• Patient: Sarah, a 60-year-old woman with type 2 diabetes
• Scenario: Sarah had difficulty managing her diabetes and experienced mild
depression (PHQ-9 score of 8). She enrolled in a telemedicine program that
included remote monitoring of her glucose levels and mental health check-ins.
• Outcome: Over the course of a year, Sarah's PHQ-9 score decreased to 4,
indicating improved mental health. Her HbA1c levels decreased from 7.8% to
7.0%, showcasing the impact of telemedicine in achieving better diabetes control
and mental well-being.
21

22. CONCLUSION
• In conclusion, telemedicine offers innovative solutions for addressing mental
health challenges among diabetes patients.
• It enhances accessibility, reduces barriers, and improves patient outcomes.
• Telemedicine's transformative potential lies in its ability to provide holistic care,
ultimately improving the lives of diabetes patients.
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