Ms. Tinh arrived at Tam Anh General Hospital, Ho Chi Minh City, with a severely necrotized right foot. Her toes were dark purple, turning black, and the infection had spread to her ankle. She presented with a high fever and blood sugar levels four times higher than normal.

Ten days prior to her hospital admission, Ms. Tinh's toe was scratched. It subsequently became swollen, pus-filled, and painful. Her daughter revealed that Ms. Tinh, despite having diabetes for 16 years, frequently neglected her medication and did not adhere to her prescribed diet. The family hesitated to intervene because Ms. Tinh often became irritable and withdrawn when reminded.

Doctor Pham Thi Thu Ha, Head of the Foot - Diabetes Unit, Endocrinology - Diabetes Department, stated that Ms. Tinh's non-adherence to treatment resulted in uncontrolled blood sugar. The foot ulcer severely progressed, leading to necrosis in three toes that required amputation. During a specialized psychological examination, doctors also diagnosed Ms. Tinh with depression.

Doctors prescribed medication to stabilize Ms. Tinh's blood sugar and blood pressure, combined with antidepressants. Her daughter received guidance on providing mental support for her mother.

Doctor caring for a patient's toenail with diabetes complications. Photo: *Tam Anh General Hospital*.

According to Doctor Ha, individuals diagnosed with diabetes often experience anxiety, stress, and fatigue, creating a vicious cycle of diabetes and depression. Stress or depression makes it difficult for patients to adhere to treatment, frequently leading to missed medication, irregular eating habits, and infrequent blood sugar monitoring. This increases their risk of vascular, cardiovascular, and neurological complications.

Mental well-being is an integral part of diabetes management. However, early symptoms of depression, such as fatigue, weight loss or gain, and sleep disturbances, are often subtle and overlooked by patients, resulting in unwanted complications.

Bach Duong

* Patient's name has been changed