The Dangerous Cycle of Anxiety and Diabetes

The current healthcare systems in the U.S. often compartmentalize health conditions, treating physical and mental health as distinct entities. This dissociative approach has led to a limited perspective on diabetes treatment focused largely on the physical symptoms. Many tend to view diabetes solely in terms of being a metabolic disorder. However, we are only addressing one side of the health equation when it comes to patient health. 

Emerging evidence suggests that mental health issues, like anxiety, are intertwined with diabetes and can significantly influence both its onset and progression. Those with diabetes have a prevalence of anxiety that is three times higher than the general population. While stress and anxiety are normal parts of life, chronic stress alters hormonal pathways, induces systemic inflammation, and disrupts metabolic balance. Addressing mental health should be seen as not merely complementary but as a fundamental part of fully understanding and managing diabetes.

Most current treatments focus on managing the physical causes and symptoms of diabetes. Pharmacological solutions like GLP-1 receptor agonists, including Wegovy and Ozempic, have proven effective in controlling blood sugar and promoting weight loss. While these drugs address the biological aspects of diabetes, they don’t address mental health, particularly anxiety, stress or trauma, which are often associated with diabetes and obesity.

There is evidence to suggest a bi-directional relationship between anxiety and diabetes, meaning there is a higher risk of anxiety disorders in patients with diabetes and vice versa. People with anxiety have a 19% higher risk of having diabetes, while diabetes is associated with a 41% higher risk of anxiety disorders. The connection between the disorders is physiological. Anxiety often activates the sympathetic nervous system, which governs the body’s fight-or-flight response by releasing neurotransmitters such as norepinephrine. This activation affects how the body processes and stores energy. 

For instance, a high-fat diet can trigger the release of these neurotransmitters, resulting in an increased breakdown of liver fat. Normally, insulin helps regulate this process, but when chronic stress keeps the sympathetic nervous system overactive, it bypasses insulin regulation. This leads to unchecked fatty acid release, insulin resistance, liver dysfunction, and ultimately, systemic inflammation, setting the stage for type 2 diabetes.

The rising use of GLP-1 drugs highlights their effectiveness in managing symptoms like weight and insulin sensitivity, but it also reveals the limitations of treating diabetes purely as a metabolic issue. Given the link between obesity and diabetes, it’s important to understand the significant connection between trauma and obesity. In fact, exposure to an adverse childhood event (ACE) is associated with a 36% greater likelihood of developing obesity, the largest cause of diabetes. 

Those individuals develop an experiential avoidance behavior whereby eating allows them to soothe the pain of their trauma. If we never address the manifestation of obesity, the likelihood of rebound weight gain in those individuals is greater. That increases anxiety and ultimately drives metabolic dysfunction through overactive stress pathways. Focusing solely on pharmacological solutions does not break this cycle of stress-induced health deterioration. Without addressing underlying anxiety and trauma, we are managing only one side of the health issue. The root cause must be addressed to achieve a healthy life balance.

Consider Whitney. She was diagnosed with diabetes and began GLP-1 therapy to manage her weight and stabilize her blood sugar levels. Physically, the treatment was successful — her weight decreased, and her glucose levels improved. However, Whitney’s underlying anxiety remained untreated. Years of chronic stress had already compromised her metabolic health, making her vulnerable to diabetes in the first place. Despite the physical improvements, the ongoing anxiety contributed to continued metabolic instability, leading to episodes of panic and renewed fears of complications like those her father had faced. Whitney’s story illustrates how untreated anxiety feeds back into the cycle of insulin resistance and diabetes, a cycle not broken by pharmacologics alone.

This complexity points to the need for a more integrated approach to healthcare in general, especially with chronic illnesses. Treatments like GLP-1 receptor agonists are incredibly effective at controlling blood sugar and managing weight, but they do not address the neurobiological effects driven by chronic anxiety, stress, or trauma. When stress triggers the sympathetic nervous system repeatedly, it creates a persistent environment that fosters metabolic dysfunction. Addressing these underlying issues requires more than medications that target blood glucose levels. Comprehensive diabetes management should involve a dual pathway treatment program that addresses both the physical symptoms and psychological factors that exacerbate them.

Mental health care must be prioritized, especially as medications like GLP-1 become more commonplace. Anxiety, trauma, and chronic stress are significant but often overlooked contributors to metabolic disorders. One in five individuals on insulin therapy experiences moderate to severe anxiety, which directly impacts their ability to manage stable blood glucose levels. By incorporating digital mental health treatments, patients can reduce the utilization of healthcare services, like emergency visits, and improve their quality of life, leading to better diabetes management and lower healthcare costs.

Effective diabetes management requires a shift from focusing purely on blood sugar levels and weight management medications to embracing the psychological and biological contributors that drive obesity and the disease. Anxiety is not just a byproduct of diabetes; it is a major driver that, if left untreated, prevents effective management of the condition. A holistic approach, integrating both physical and mental health care, offers a more comprehensive path to improving patient outcomes and providing the patient with a better quality of life.

Photo: PixelsEffect, Getty Images

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