Prediabetes and the risk of type 2 diabetes: Investigating the roles of depressive and anxiety symptoms in the Lifelines cohort study

Diabet Med. 2023 Jul;40(7):e15061. doi: 10.1111/dme.15061. Epub 2023 Feb 17.

Abstract

Aims: Depression and anxiety may increase the risk of progressing from prediabetes to type 2 diabetes. The present study examined the interactions between prediabetes status and elevated depressive and anxiety symptoms with the risk of type 2 diabetes.

Methods: Participants (N = 72,428) were adults aged 40 years and above without diabetes at baseline from the Lifelines Cohort Study (58% female; mean age = 51.4 years). The Mini-International Neuropsychiatric Interview screened for elevated symptoms of major depressive disorder and generalized anxiety disorder. Glycated haemoglobin A1c (HbA1c ) levels determined prediabetes status at baseline (2007-2013), and HbA1c and self-reported diabetes diagnoses determined diabetes status at follow-up (2014-2017). Groups were formed for elevated depressive and anxiety symptoms, respectively, and prediabetes status at baseline (elevated depressive/anxiety symptoms with prediabetes, elevated depressive/anxiety symptoms alone, and prediabetes alone), and compared to a reference group (no prediabetes or anxiety/depression) on the likelihood of developing diabetes during the follow-up period.

Results: N = 1300 (1.8%) participants developed diabetes. While prediabetes alone was associated with incident diabetes (OR = 5.94; 95% CI = 5.10-6.90, p < 0.001), the group with combined prediabetes and depressive symptoms had the highest likelihood of developing diabetes over follow-up (OR = 8.29; 95% CI = 5.58-12.32, p < 0.001). Similar results were found for prediabetes and anxiety symptoms (OR = 6.57; 95% CI = 4.62-9.33, p < 0.001), compared to prediabetes alone (OR = 6.09; 95% CI = 5.23-7.11, p < 0.001), though with a smaller effect. The interaction between depressive symptoms and prediabetes was synergistic in age-and-sex adjusted analyses.

Conclusions: Individuals with elevated depressive, and to some extent anxiety, symptoms in combination with prediabetes may represent a high-risk subgroup for type 2 diabetes.

Keywords: anxiety; depression; mental health; prediabetes; prediction of diabetes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anxiety / epidemiology
  • Anxiety / psychology
  • Cohort Studies
  • Depression / epidemiology
  • Depression / psychology
  • Depressive Disorder, Major* / complications
  • Depressive Disorder, Major* / epidemiology
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / diagnosis
  • Diabetes Mellitus, Type 2* / epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prediabetic State* / complications
  • Prediabetic State* / diagnosis
  • Prediabetic State* / epidemiology
  • Risk Factors