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Depression may hasten death in people with type 2 diabetes. Image credit: Yasser Chalid/Getty Images.
  • Worldwide, type 2 diabetes affects more than 6% of people, or around 462 million individuals, and it is the ninth leading cause of mortality.
  • Mental health issues are common in people with type 2 diabetes, with studies finding that depression is twice as likely in those with type 2 diabetes as in those without the condition.
  • Now, a study has found that the risk of premature death in people with both type 2 diabetes and depression is four times that of people with neither condition.
  • The authors call for the integration of mental health care into the medical treatment of people with type 2 diabetes.

In 2017, an estimated 462 million people, or 6.28% of the world’s population had type 2 diabetes, according to a study using the Global Burden of Disease dataset.

Since then, the number has increased, and the total number of people with type 2 diabetes worldwide is projected to reach more than 1.3 billion by 2050.

People with diabetes are at greater risk of developing depression than those without the condition. According to the World Health Organization (WHO), some 5% of adults globally experience depression, or depressive disorder, and studies have found that those with type 2 diabetes are twice as likely to have depression as the general population.

Both conditions increase the risk of mortality, but now, a study has found that the combination of depression and type 2 diabetes can increase the risk of death by up to four times.

Dr. Robert Gabbay, chief scientific and medical officer for the American Diabetes Association, not involved in this research, told Medical News Today:

“This [study] adds to the data that indicates people with diabetes and depression do significantly worse. Clearly depression is an important risk factor for poorer outcomes for people living with diabetes and unfortunately depression is more common in people with diabetes.”

The study, from New Mexico State University and Walden University Minneapolis, is published inDiabetes & Metabolic Syndrome: Clinical Research & Reviews.

“Globally, it is estimated that almost a fifth of people with diabetes may also have depression symptoms of varying severity,” Dr. Jagdish Khubchandani, lead and corresponding author on the new study, and professor of public health at New Mexico State University, told MNT.

The researchers analysed data from 14,920 participants from the 2005–2010 National Health and Nutrition Examination Survey. They then linked these data to death records from the Centers for Disease Control and Prevention (CDC) up to December 31, 2019.

For diabetes status, the researchers asked participants: “Other than during pregnancy, have you ever been told by a doctor or other health professional that you have diabetes or sugar diabetes?” If they answered “yes” or “borderline,” the researchers recorded this as diabetes.

They recorded depression using the PHQ-9 — a questionnaire that assesses severity of depression. The questionnaire has a maximum score of 27, and anyone with a score of 10 or higher was considered to have depression.

Of the cohort, 9.08% had depression, and 10% had type 2 diabetes. Of those with type 2 diabetes, 16.6% also had depression.

After adjusting for sociodemographic factors, the researchers found that, overall, participants with type 2 diabetes were 1.7 times more likely to die prematurely than those without the condition.

For people who had both type 2 diabetes and depression, the risk of early death was more than four times the risk of people with neither condition.

Dr. Khubchandani called for coordinated care for people with type 2 diabetes:

“The need is for collaborative care among interdisciplinary teams. Such prevention and therapy strategies have the potential to improve depression symptoms, control blood sugar, improve quality of life, and add years of life.”

“Specialists in diabetes care may not be able to assist alone given the variety of other conditions including depression that frequently occur with diabetes,” he added.

Dr. Gabbay echoed this perspective, noting that “[t]he American Diabetes Association Standards of Care recommends routine screening for depression because it is common in people with diabetes, is a predictive of poor outcomes, and now even more startlingly, increases the risk of death.”

“Given that there are effective treatments for depression, it is critical to screen for depression, which can be as simple as to question PHQ-2 [questionnaire about frequency of depressed mood] and then focus on appropriate treatments,” he continued.

Inflammation, sleep disturbance, inactive lifestyle, poor dietary habits, and environmental and cultural risk factors may all contribute to both diabetes and depression, as Dr. Gabbay explained.

“There are a number of factors that may explain the connection between depression and type 2 diabetes. People with depression are often less likely to engage in healthy lifestyles, which can lead to worse glucose control and higher risk of complications of diabetes,” he noted.

“There also seems to be some biological connection between depression and type 2 diabetes that we do not fully understand but may be an important factor,” Dr. Gabbay added.

Dr. Khubchandani emphasized the importance of treatment for both conditions.

“While getting treatment for any of the two disorders is better than no care, a combination of antidepressants and hypoglycemic drugs are recommended for optimum management of both the disorders and to prevent worsening of any of these,“ he told us.

“For this to happen, frequent monitoring and screening is key and diabetes care practitioners must remain vigilant about mental health issues among patients,” he further pointed out.

Dr. Khubchandani also urged that action should be taken soon to prevent unnecessary deaths from diabetes.

“As of today, more than 400 million people globally have diabetes and this number will quickly be doubled by 2050,” he stressed, warning that “[d]iabetes imposes a lot of social, economic, and emotional burdens. Unless we start addressing mental health issues more seriously and comprehensively, more people with diabetes will die prematurely.”