Patients with complications of diabetes mellitus have elevated rates of mood and cognitive disorders. Concomitantly, some psychiatric disorders might be associated with increased risk for subsequent diabetes. To study these relationships, investigators in a study with some industry funding used World Health Organization data from 19 countries based on household surveys assessing respondents for 16 DSM-IV diagnoses (mood, anxiety, impulse control, and substance use disorders); respondents also self-reported the presence of select physician-diagnosed chronic health conditions. Among 52,095 surveys, 2580 cases of adult-onset diabetes were identified (onset age, ≥21 years; mean, 50 years). Rates of all mental disorders studied, except obsessive-compulsive disorder and agoraphobia without panic, were elevated in respondents with self-reported diabetes (odds ratios for bivariate associations, 1.3–3.8). After adjustments for psychiatric comorbidity, age, sex, illness duration, and country, four psychiatric disorders remained associated with subsequent development of diabetes: binge-eating disorder (OR, 2.6), bulimia nervosa (OR, 2.1), intermittent explosive disorder (OR, 1.6), and major depression (OR, 1.3).
This study didn't differentiate between type I and type II diabetes and offered no data on lifestyle factors potentially linking psychiatric disorders, how individuals cope with them (e.g., dietary habits, body-mass index, psychiatric medications), and the subsequent development of diabetes. The strong association of binge-eating disorder (which commonly leads to obesity) with subsequent diabetes is unsurprising. Mechanisms linking other disorders to later diabetes are less evident, but might include common genetic predispositions or, more likely, other stress-related neurohumoral, inflammatory, or other psychosocial and lifestyle factors. Certainly, some psychiatric medications increase insulin resistance. Because associations between psychiatric disorders and diabetes are bidirectional, clinicians treating these psychiatric disorders should know that their patients are at increased risk for diabetes and require suitable monitoring and intervention.
- de Jonge P et al. Associations between DSM-IV mental disorders and diabetes mellitus: A role for impulse control disorders and depression. Diabetologia 2014 Apr; 57:699. (http://dx.doi.org/10.1007/s00125-013-3157-9)