The Mental Health Coverage Gap in Type 1 Diabetes Care

Managing Type 1 diabetes means making dozens of decisions every day—how much to eat, when to dose, whether to correct. This constant mental load can be exhausting. For many, the result is burnout, anxiety, and depression. Yet, despite how common these challenges are, mental health remains one of the least-supported aspects of T1D care.

Emotional Strain, Lifelong Pressure

Studies show that people with T1D are two to three times more likely to experience depression or anxiety than the general population. Teens and young adults are especially vulnerable, juggling disease management with academic and social pressures. CGMs and pumps can reduce stress but also create “data fatigue,” where constant alerts fuel guilt or panic over imperfect control.

Even mild distress can spiral: people experiencing diabetes burnout are more likely to skip insulin doses, avoid blood sugar checks, and withdraw from social or medical support. Yet most healthcare systems treat these struggles as secondary to physical care.

Why Coverage Fails

Insurance rarely recognizes mental health as an essential part of diabetes management. Behavioral health visits are often billed separately and excluded from endocrinology care. Many diabetes clinics lack on-site psychologists or social workers, meaning patients must seek outside therapy—and pay out of pocket.

As of 2023, only 17% of diabetes care centers in the U.S. had access to mental health professionals familiar with diabetes. Even when therapy is available, few clinicians are trained to address condition-specific issues like hypoglycemia fear or insulin guilt.

Policy Models That Work

California’s CalAIM and Massachusetts’s Behavioral Health Integration Program have begun reimbursing mental and physical care jointly—an approach that could be expanded nationally. Policies that deserve federal attention include:

• Integrating behavioral health codes into diabetes care billing, allowing endocrinologists to collaborate with psychologists under one reimbursement plan.

• Expanding Medicare and Medicaid coverage for diabetes-specific mental health services, including teletherapy.

• Funding mental health training for Certified Diabetes Care and Education Specialists (CDCESs) to recognize and respond to distress early.

• Requiring mental health screenings as part of routine T1D clinic visits, similar to blood pressure checks.

A Holistic Standard of Care

Diabetes management doesn’t end at glucose numbers. Emotional well-being affects blood sugar stability as much as insulin type or pump brand. Policy that integrates mental and physical care would not only improve health outcomes but restore a sense of humanity to chronic disease management—something no app or device can replace.