HEALTH

The Bidirectional Relationship between Diabetic Retinopathy and Adverse Mental Health
by Maya Khurana

Diabetes is a common health condition affecting approximately 37.3 million people in the United States. There are several types of diabetes, including autoimmune forms like Type 1 and gestational diabetes, but the most common form is Type 2 diabetes, accounting for 90-95% of all cases (1). In type 2 diabetes, the body’s cells become resistant to insulin, a hormone critical for regulating sugar in the body, resulting in elevated blood sugar levels or hyperglycemia.

Complications of Chronic Hyperglycemia

Hyperglycemia may not cause symptoms immediately, but it can lead to serious complications over time. Chronic hyperglycemia damages blood vessels and organs, increasing the risk of cardiovascular disease, kidney failure, and diabetic retinopathy– a condition causing eye damage that can lead to vision loss and blindness. These are devastating consequences that affect patients’ daily lives, both functionally and emotionally.

Risk Factors

Various factors increase the risk of developing diabetes, ranging from medical contributors like family history, obesity, and physical inactivity, to social determinants of health like neighborhood and environmental conditions, food access, and healthcare availability (2, 3).

Similarly, mental health is an emerging risk factor for developing diabetic retinopathy that researchers are investigating deeper (4). The link between diabetic retinopathy and mental health is important because of its apparent bi-directionality. Developing diabetic retinopathy can put patients at risk of developing mental illnesses like depression or anxiety. Simultaneously, if patients have mental health conditions, they are at greater risk of developing diabetic retinopathy long term. This is because mental illness can interfere with maintaining healthcare follow-up and cause difficulties managing chronic conditions like diabetes, increasing risk of complications (5). On the other hand, when patients with diabetic retinopathy begin to experience vision decline, their ability to navigate the world is altered drastically (6). This might cause disengagement from routine activities and social isolation, leading to feelings of depression.

Prevention and Care

To prevent progression to retinopathy, patients with diabetes need to be able to access and pursue health care long-term. Additionally, understanding the two-way relationship between diabetic retinopathy and mental health helps us identify risk factors and plan for long-term wellness. There are two crucial elements to managing chronic diabetes: routine check-ins with health care providers and maintaining a healthy and active lifestyle to prevent the condition from worsening (7). This means following a balanced diet comprised of vegetables, fruits, protein, and carbohydrates, as well as engaging in 150 minutes of moderate to vigorous physical activity weekly. Another aspect of a healthy lifestyle is maintaining mental well-being. Relying on support systems within our community and reaching out to trusted friends, family, and health care providers can help when difficult moments arise. Moreover, creating a reliable, structured routine can provide stability and help those managing mental health conditions thrive (8).

Therefore, when it comes to navigating chronic conditions– whether it be diabetes, a mental health condition, or both– the classic adage prevails: an ounce of prevention is worth a pound of cure. By deliberately and consistently caring for our own physical and mental well-being, we can give ourselves the best chance to live our healthiest and happiest lives.

References:
1. Cleveland Clinic. Diabetes. Cleveland Clinic. Published February 17, 2023. https://my.clevelandclinic.org/health/diseases/7104-diabetes
2. Centers for Disease Control and Prevention. Diabetes Risk Factors. Diabetes. Published 2024. https://www.cdc.gov/diabetes/risk-factors/index.html
3. Hill-Briggs F. Social determinants of health and diabetes: A scientific review. Diabetes Care. 2020;44(1):258-279. doi:https://doi.org/10.2337/dci20-0053
4. Li J, Sun H, Li L, et al. Depression and diabetic retinopathy: an underexplored connection. Frontiers in Nutrition. 2025;12. doi:https://doi.org/10.3389/fnut.2025.1557105
5. Li B, Zhou C, Gu C, et al. Modifiable lifestyle, mental health status and diabetic retinopathy in U.S. adults aged 18–64 years with diabetes: a population-based cross-sectional study from NHANES 1999–2018. BMC public health. 2024;24(1). doi:https://doi.org/10.1186/s12889-023-17512-8
6. Louay Almidani, Miller R, Varshini Varadaraj, Mihailovic A, Swenor BK, Ramulu PY. Vision Impairment and Psychosocial Function in US Adults. JAMA Ophthalmology. Published online February 22, 2024. doi:https://doi.org/10.1001/jamaophthalmol.2023.6943
7. CDC. Physical activity for adults: An overview. Physical Activity Basics. Published December 20, 2023. https://www.cdc.gov/physical-activity-basics/guidelines/adults.html
8. Hou WK, Lai FT, Ben-Ezra M, Goodwin R. Regularizing daily routines for mental health during and after the COVID-19 pandemic. Journal of Global Health. 2020;10(2). doi:https://doi.org/10.7189/jogh.10.020315

The images were provided by the author.

Maya Khurana is a second-year medical student at the University of Rochester School of Medicine and Dentistry. Originally from California, she earned her bachelor’s degree in Neuroscience from Yale University and is planning to specialize in Neurology. Maya is passionate about practicing mental wellness and preventative medicine, and she strives to educate her community about both. Outside of school, Maya enjoys singing with her colleagues at the medical school, spending time with friends and family, and soaking in as much sunshine as possible!