Aims/Hypothesis: The independent association of depressive symptoms and diabetes distress (DD) with the mortality risk in patients with diabetes has not been evaluated. We examined the temporal joint association of DD and depression at baseline and the subsequent risk of all-cause mortality.

Methods: The longitudinal data of 3118 patients with type 2 diabetes were obtained from a large Japanese diabetes registry. To assess the joint association of DD and depression at baseline with the subsequent risk of all-cause mortality, the Cox proportional hazards model was used with adjustment for potential confounders.

Results: The mean age, body mass index, and HbA1c level were 64.7 years, 24.6 kg/m2, and 58.6 mmol/mol (7.5%), respectively, and 38.1% of the participants were women. We observed 238 of any death cases during the median follow-up of 7.1 years (incidence ratio = 12.3 per 1000 person-years). In the multivariable-adjusted models evaluating the DD and depression separately, the hazard ratios (HRs) of all-cause mortality were 1.67 (95% confidence interval [CI], 1.14-2.43; p = 0.008) and 1.40 (95%CI, 1.05-1.85; p = 0.020), respectively. In such models evaluating the joint association of DD and depression, compared with DD (−)/depression (−), the HRs of all-cause mortality for DD (−)/depression (+), DD (+)/depression (−), and DD (+)/depression (+) were 1.34 (95%CI, 0.99-1.86; p = 0.056), 1.96 (95%CI, 1.10-3.50; p = 0.023), and 1.71 (95%CI, 1.06-2.77; p = 0.029), respectively. In the stratified analysis by gender, the aforementioned significant association was observed only in men.

Conclusions: We observed a significant independent association of DD and depression with all-cause mortality in male patients with type 2 diabetes, and this finding was only observed in men, not in women. Further research is needed to determine the mechanism of the association between DD or depression and mortality.


Y. Hayashino: None. S. Okamura: None.


Manpei Suzuki Diabetes Foundation; Japan Society for the Promotion of Science (25460641)

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