From Diabetes Complications to Mental Health Challenges: Understanding the Two-Way Street

The findings highlight the important relationship between CDCs and MHDs. Addressing either condition through prevention or treatment measures could potentially lower the risk of developing the other.

"Individuals diagnosed with CDCs faced a significantly elevated risk of developing MHDs. Conversely, those with MHDs had an increased likelihood of developing CDCs, with this association particularly pronounced among younger age groups," the researchers reported.

Additionally, Type 1 diabetes (T1D) showed a stronger correlation with CDCs in individuals under the age of 60, whereas type 2 diabetes (T2D) exhibited a closer relationship with MHDs.

Brian C. Callaghan, Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, and colleagues conducted the study to determine bidirectional associations between the timing of chronic diabetes complications and mental health disorders in individuals with type 1 or type 2 diabetes.

For this purpose, the researchers used a nationally representative healthcare claims database. They identified matched individuals with T1D or T2D or without diabetes using a propensity score quasi-randomization technique stratified by age (0–19, 20–39, 40–59, and 60+ years). Using ICD-9/10 codes, CDCs and MHDs were identified. Cox proportional hazards models were fit with time-varying diagnoses of CDCs or MHDs to examine their association with the hazard of developing MHDs or CDCs, respectively.

The study revealed the following findings:

• A total of 553,552 individuals were included (44,735 with type 1 diabetes, 152,187 with type 2 diabetes, and 356,630 without diabetes) from 2001 to 2018.
• Having a CDC increased the hazard of developing an MHD (hazard ratio [HR] 1.9–2.9, with higher HRs in older age strata), and having an MHD increased the hazard of developing a CDC (HR 1.4–2.5, with the highest HR in age stratum 0–19 years).
• In those aged <60 years, individuals with type 1 diabetes were more likely to have CDCs, whereas individuals with type 2 diabetes were more likely to have MHDs.
• The relationship between CDCs and MHDs in either direction was not affected by diabetes type.

"Our research revealed a persistent mutual relationship between chronic diabetes complications and mental health disorders throughout all stages of life, emphasizing their significant interconnection. Addressing either condition through prevention or treatment measures could potentially mitigate the risk of developing the other," the researchers concluded.

Reference:

Maya Watanabe, Evan L. Reynolds, Mousumi Banerjee, Morten Charles, Kara Mizokami-Stout, Dana Albright, Lynn Ang, Joyce M. Lee, Rodica Pop-Busui, Eva L. Feldman, Brian C. Callaghan; Bidirectional Associations Between Mental Health Disorders and Chronic Diabetic Complications in Individuals With Type 1 or Type 2 Diabetes. Diabetes Care 2024; dc240818. https://doi.org/10.2337/dc24-0818