Bidirectional Associations Between Chronic Diabetes Complications and Mental Health Disorders, revealed in new Study

A groundbreaking study revealed that there is a stable, constant, and bidirectional relationship between chronic diabetic complications (CDCs) and mental health disorders (MHDs) in an individual. The study highlighted the importance of their relationship and the importance of preventing comorbidity to reduce the disease risk. The study results were published in the journal Diabetes Care. 

Diabetes is a global pandemic and individuals with type 1 or type 2 diabetes are at an increased risk of developing chronic diabetic complications and mental health disorders. Diabetic individuals can develop multiple complications. The development of complications can affect the mental health of the individuals. Hence, researchers from Michigan State University conducted a study to understand the bidirectional associations between the timing of chronic diabetes complications (CDCs) and mental health disorders (MHDs) in individuals with type 1 or type 2 diabetes. 

Researchers used the nationally representative health care claims database to identify individuals with type 1 or type 2 diabetes and a matched cohort without diabetes. Propensity score matching was employed to quasi-randomize the cohorts and stratify the individuals by age groups like 0–19, 20–39, 40–59, and ≥60 years. ICD-9/10 codes were used to diagnose CDCs and MHDs to capture both diabetes-related complications and mental health conditions. Cox proportional hazards models were used to explore the relationship between CDCs and MHDs. The influence of one condition leading to the development of the other were determined by incorporating time-varying diagnoses of CDCs and MHDs. 

Findings:

• The study analyzed data from 553,552 individuals spanning from 2001 to 2018.
• This included 44,735 individuals with type 1 diabetes, 152,187 individuals with type 2 diabetes, and 356,630 individuals without diabetes.
• A significant bidirectional association was found between CDCs and MHDs.
• Specifically, individuals who developed a CDC were at a higher risk of subsequently developing an MHD, with hazard ratios (HRs) ranging from 1.9 to 2.9 (P < 0.05).
• Old age grouped individuals had higher risk than others.
• Similarly, individuals with a pre-existing MHD had an elevated risk of developing a CDC, with HRs between 1.4 and 2.5 (P < 0.05), with the highest risk observed in the 0–19 years age group.
• Further analysis revealed differences in the likelihood of developing CDCs and MHDs between individuals with type 1 and type 2 diabetes.
• Among those under the age of 60 the study found that individuals with type 1 diabetes were more prone to developing CDCs, while individuals with type 2 diabetes had a higher likelihood of developing MHDs.
• However, the overall relationship between CDCs and MHDs did not differ by diabetes type.
• Interaction effects between CDCs and MHDs across different types of diabetes were not significant (P > 0.05). 

Thus, the study determined an immense bidirectional relationship between chronic diabetes complications and mental health disorders across all age groups. Individuals who develop CDCs are at a greater risk of developing MHDs, and vice versa and hence it is important to recognize and address the interplay between physical and mental health in diabetes care and address both physical and mental health outcomes across the lifespan. 

TAKE-HOME MESSAGE

• This study examined the bidirectional associations between mental health disorders and chronic diabetes complications in individuals with type 1 or type 2 diabetes by analyzing data from a nationally representative healthcare claims database.
• Using the data the authors analyzed 44,735 individuals with type 1 diabetes and 152,187 individuals with type 2 diabetes.
• Having a chronic diabetes complication increased the risk of developing a mental health disorder (HR, 1.9–2.9) and having a mental health disorder increased the risk of developing a chronic diabetes complication (HR, 1.4–2.5).
• There is a bidirectional association between mental health disorders and chronic diabetes complications in individuals with type 1 and type 2 diabetes.

Further reading: Watanabe M, Reynolds EL, Banerjee 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):1638-1646. doi:10.2337/dc24-0818