Diabetes mellitus in the patient with psychological problem: an issue of concern.

Sir,

Diabetes mellitus is an important basic health problem that can be found all around the world. Millions of people in the world are affected by this disease. Several co-morbidities can be seen in diabetic patients. The examples include coronary heart disease, dyslipidemia, hypertension, and many other somatic disorders. However, psychological disorder remains a forgotten issue. According to a previous report, considerably high prevalence of psychiatric morbidity among diabetics could be seen.[1] Among the psychiatric problems, anxiety is the most common condition.[1] Here, the author would like to discuss a case study on a diabetic patient with poor diabetic control and fluctuation of blood glucose. This case was a 45-year-old male, who visited the diabetic clinic regularly. The case had fluctuation in blood glucose level between high and low levels. Observing that this patient had obsessive and compulsive questions on practices for his diabetic control, he was referred to a psychiatrist and was finally diagnosed as a psychic patient with anxiety disorder. The patient expressed thus: “I try to attach to the recommendations of the physician but I am not sure about the recommendation and tried asking many ones. I got many suggestions from my friends and cousins and I tried to practice for all (such as using ritual fauna diabetic regimen, intake of many fruits, intake of yoghurt, etc.). Also, I eat antidiabetic according to the pharmacist's labeling and if I think I forget, I will eat it again. I think I am the best diabetic patient with good follow-up and practice according to the physician's suggestions.” This case is not an uncommon case, but it reflects the importance of concern on underlying psychological problem in poorly controlled diabetes mellitus. Lange et al. suggested that disease management programs for patients with diabetes mellitus types I and II should include psychosomatic-psychotherapeutic diagnostics.[2] As a recommendation, the author suggests the following: (a) the annual psychological examination for all diabetic patients by a psychologist, (b) the physician in charge and health worker team have to pay attention to the psychological factor in managing of the diabetic patients, and (c) referring to the psychologist for the diabetic cases with poor compliance.