Much has been written about the complications associated with diabetes, but the psychological consequences are often overlooked or ignored.

One psychological disorder commonly associated with diabetes is anxiety. Diabetes UK, the leading diabetes charity in Britain, says that diabetic patients are 20 percent more likely to experience an anxiety disorder than people without the disease. This results largely from worry about experiencing hypoglycaemia-related complications while working or driving.

Similarly, a seizure or loss of consciousness as a result of hypoglycaemia can lead to post-traumatic stress disorder, which can get worse if not diagnosed in time.

Anxiety and depression commonly coincide. The Canadian Diabetes Association estimates that 15 percent of diabetic patients experience a major depressive disorder. That is almost double the rate in the general population. Being told that you have a life-altering, potentially fatal illness would, after all, upset most people. And having to cope with daily self-care can lead people to despair.

However, a number of studies suggest that depression occurs before the onset of diabetes. The life-changing events associated with diabetes may give rise to a depressive episode, but, on the other hand, being depressed often leads to reduced physical activity and weight gain - both factors that could contribute to the onset of diabetes.

Whichever comes first, depression or diabetes, the relationship is not a good one. Repeatedly, research has shown that depressed diabetics have poorer clinical outcomes, in rates of both amputation and mortality.

The bottom line is that depression greatly exacerbates diabetes, and treating depression would improve its clinical management. This is well documented, and yet physical health and psychological health specialists often don't talk and may not even inhabit the same healthcare facility.

Eating disorders are another psychological problem associated with diabetes. Anorexia and bulimia are most common among young women and teenage girls. And women with Type 1 diabetes are, says the American Diabetes Association (ADA), at increased risk of developing eating disorders.

Type 1 diabetics are required to take insulin because their body cannot produce enough of it, but the insulin therapy can result in weight gain. Consequently, in our body-image-obsessed societies, some women develop eating disorders after a medically-induced weight gain. Others just cut down on the meds: the ADA says as many as 40 percent of young women refuse to take insulin injections as prescribed for the fear of weight gain.

A 2008 study published in the journal Psychiatry reported the prevalence of anorexia nervosa in a population of diabetic females as 0.27 percent compared to 0.06 percent of a comparable non-diabetic control group. The same pattern was found for bulimia nervosa: 1.73 percent and 0.69 percent.

The well documented psychological problems associated with the illness suggest that the best care and prevention has to include a psychological and psychotherapeutic aspect. More should be done to offer holistic treatment, including talk-based psychotherapies, particularly in cases involving depression.

That should go hand in hand with campaigns that aim to remove the stigma associated with psychological interventions. Findings that imply depression precedes diabetes suggest we might benefit from preventive initiatives aimed at promoting psychological health, making it less likely that people will develop depression in the first place.

Diabetes is one of the world's greatest health challenges. Psychology and psychological therapies can be useful in helping to manage this serious problem.

The writer is a student of Psychology at the Zayed University. This article has been reproduced from the Arab News.