Panic Attacks Can Increase Complications in Diabetes Patients

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People with diabetes who have repeated panic attacks are less likely to have properly managed the disease and suffer more severe health complications and poorer quality of life, a new study finds.

Lead author Evette Ludman, Ph.D., a researcher with Group Health Cooperative in Seattle, said her group’s previous work showed depression was associated with more poorly controlled glucose, more diabetes symptom, and lower functioning. “But because panic and depression so often go hand in hand, we weren’t certain that patients who have panic, independent of depression, would also have with these indicators.”

For the new study, which appears in the November issue of General Hospital Psychiatry, a survey was mailed to 4,385 patients with diabetes. Of those participants, 193 (4.4 percent) reported having panic episodes that caused a definite change in behavior. Among the 193 patients, 54.5 percent also had symptoms of depression.

Respondents were asked about recent panic or fear “spells” and if these feelings forced them to change their behavior. Participants were also given questionnaires that measured their diabetes symptoms as well as their level of functioning and disability.

Of those with panic disorder, the average HbA1c levels — a measure of long-term glucose control — were 8.1 percent compared with 7.7 percent for those without panic episodes. (Usual treatment goal is to keep levels below 7 percent.) Also, those with panic episodes reported having an average of 4.2 diabetes symptoms compared with 2.4 symptoms in those without panic.

Panic disorder is characterized by recurrent panic attacks, followed by persistent worry about having another attack.

The authors say that panic symptoms might be a consequence of diabetes itself. Panic episodes may contribute to poor outcomes by interfering with self-care and patients’ ability to follow their treatment regimens.

The authors and diabetes experts agree that if physicians treating patients with diabetes can better recognize and treat the symptoms of panic episodes and depression, they can improve the patients’ quality of life.

“I think most careful clinicians have noted that there are patients who do not cope well with their diabetes and have a variety of neuropsychosocial issues including panic disorder, depression, anxiety and personality disorders,” said John Buse, M.D., division chief of the Diabetes Center at University of North Carolina at Chapel Hill. “The key really is to very carefully assess patients who are not doing well in their management of diabetes or other chronic illness.”

General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Wayne Katon, MD, at (206) 543-7177.

Ludman E, et al. Panic episodes among patients with diabetes. General Hospital Psychiatry 28: 475-481, 2006.

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