A RECENT study, led by Maya Watanabe, University of Michigan, USA, has highlighted the strong bidirectional relationship between chronic diabetes complications (CDCs) and mental health disorders (MHDs) in individuals with type 1 or type 2 diabetes.
Researchers aimed to explore how the timing of these conditions influences the risk of developing the other. By analysing a nationally representative healthcare claims database, they matched individuals with type 1 or type 2 diabetes to those without diabetes, using a quasi-randomisation technique and stratifying participants by age groups.
The study, spanning from 2001–2018, included data from 553,552 individuals and observed that those with CDCs, such as heart attacks, strokes, and nerve damage, were significantly more likely to develop MHDs such as anxiety or depression. Hazard ratios (HR) ranged from 1.9 to 2.9, with older age associated with higher risk. Conversely, individuals with MHDs had an increased likelihood of developing CDCs, with HRs between 1.4 and 2.5. This association was most pronounced in younger individuals aged 0–19 years.
The findings showed that the relationship between CDCs and MHDs was consistent regardless of diabetes type, indicating a fundamental link between these comorbidities. These results underscore the importance of integrating mental health screening into standard diabetes care, alongside routine monitoring for chronic physical complications. Younger adults with type 1 diabetes were more prone to developing CDCs, while those with type 2 diabetes were more likely to experience MHDs. Researchers suggest that the relationship between these conditions may arise from both direct and indirect effects.
Additionally, common risk factors such as obesity, poor glycaemic control, and social determinants of health may contribute to the co-occurrence of these conditions. This emphasises the need for diabetes care providers to address these shared risk factors, potentially preventing multiple complications simultaneously.
Katie Wright, EMJ
Reference
Watanabe M et al. Bidirectional associations between mental health disorders and chronic diabetic complications in individuals with type 1 or type 2 diabetes. Diabetes Care. 2024;47(9):1638-46
