Depression as a barrier to tight glycaemic control: Controlling peaks and valleys

Evidence from meta-analysis demonstrates that diabetes doubles the likelihood of depression. This commonly overlooked comorbidity affects more than 25% of the diabetic population, opposes efforts to establish self-care of diabetes, contributes to hyperglycaemia, and increases the risk of diabetes complications. In turn, poor glycaemic control may exacerbate depression and diminish response to antidepressant regimens. Both psychotherapy and pharmacotherapy are effective in the presence of diabetes, and relief of depression is associated with enhanced glycaemic control. Optimal treatment of depression in diabetes requires dual management of both depression and hyperglycaemia.