Diabetes sufferers are significantly more likely to die by suicide or from alcohol related issues because of the toll on their mental health caused by managing the condition, a study has found.

While the increased risk of physical health conditions like cardiovascular disease and cancer is well understood in diabetes, the Finnish researchers warn that addiction and psychological impacts are neglected.

Alcohol deaths, predominantly cirrhosis of the liver, were up to 10 times higher than among the Finnish population studied, while deaths by suicide were increased up to 110 per cent.

The biggest increases were seen among patients whose condition was more severe and required regular insulin injections to avoid serious health complications.

“We know that living with diabetes can lead to a mental health strain,” Professor Leo Niskanen of the University of Helsinki, who led the study in the European Journal of Endocrinology, said.

Monitoring glucose levels and giving themselves daily insulin injections can have a huge impact when every meal or bit of exercise has to be factored in.

“This strain combined with the anxiety of developing serious complications like heart or kidney disease may also take their toll on psychological well-being,” Professor Niskanen said.

For the study the researchers used Finnish health records from 434,629 individuals, including 208,148 patients with diabetes.
They followed the group for an average of seven years and looked at differing death rates between patients taking different medications.

Those who only took oral antidiabetic medication (71 per cent of the group) had type 2 diabetes, a form of the condition closely linked to obesity and diet.

While patients taking insulin include patients with type 1 diabetes, who cannot produce insulin to control their blood sugar, and those type 2 diabetics who have had the condition for long enough that their cells no longer respond to the insulin they produce.

There were 2,832 deaths related to alcohol and 853 deaths by suicide during the study period, with overdose being the main cause among diabetics. There were 3,187 deaths caused by accidents, predominantly falls.

Among patients taking insulin, whose condition is most complex, deaths from alcohol related conditions were 6.9 times higher among diabetic men, and 10.6 times higher among women.

Deaths by suicide more than doubled among men receiving insulin (110 per cent increase) while among women, who are less likely to die by suicide in the general population, they still increased 49 per cent.

Patients taking oral medication had a less arduous treatment regime, and can control their condition with diet and exercise, but there was still evidence of increased risk of deaths.

For alcohol deaths the increase was 70 per cent for men, and 110 per cent increase for women, while suicides were 14 per cent and 62 per cent higher respectively.

Even though there were more than 400,000 participants, the small numbers of deaths in some groups - such as the 21 suicides recorded among female, insulin-dependent diabetics in the study - increases the likelihood that the risk increase is down to chance.

But Professor Niskanen told The Independent: “The low absolute suicidal rates makes the risk ratios look very high – even small increase in risk may thus have higher risk ratios … However, they are highly [statistically] significant anyway.”

He said: “This study has highlighted that there is a need for effective psychological support for people with diabetes. If [diabetes patients] feel like they are under a heavy mental burden or consider that their use of alcohol is excessive, they should not hesitate to discuss these issues with their primary care physician.”

Nine out of 10 patients in the UK have type 2 diabetes and since 1996, the number of people diagnosed with diabetes in the UK has increased from 1.4 million to 2.9 million. And by 2025 it is estimated that it will affect around one in every seven adults – around five million people.

Dr Emily Burns, head of research communications at Diabetes UK, said the Finnish data does not necessarily apply directly to UK patients. 

She said: “Diabetes is a complex and demanding condition so the impact on emotional and psychological wellbeing can be profound. The results of our Future of Diabetes survey showed that as many as 3 out of 5 people with diabetes reported sometimes or often feeling down as a result of their condition.

“It‌s vital that people with diabetes have access to psychological and emotional support through their diabetes team and  referral to specialist support where necessary.”