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Do Anxiety, Depression and Metabolic Syndrome Increase the Risk of Type 2?

Depressive symptoms have been associated with type 2 diabetes mellitus (T2DM), but less is known about other anxiety disorders that can be comorbid or exist without depression…

This study examined patients at risk for type 2 diabetes and its correlation to anxiety, depression or metabolic syndrome in the at risk group. The patients were defined at risk by using the FINDRISK score. The FINDRISK score is a screening tool for identifying high-risk subjects in the population, and is a standard application to subjects visiting the outpatient clinic for diabetes prevention in Germany. Patients were also assessed by using standardized test and interviews to identify any mental disorders and by obtaining anthropometric and metabolic profiles based on OGTT. Exclusion criteria were: diagnosed diabetes mellitus, severe renal disease, disease with a strong impact on life expectancy, and therapy with drugs known to influence glucose tolerance (thiazide diuretics, beta blockers, steroids, antipsychotics, TCA’s, or SSRI’s).

Metabolic syndrome was defined according to the criteria of the National Cholesterol Education Adult Treatment Panel III-R. Defined as; waist circumference >102 cm in men and >88 cm in women; hypertriglyceridemia ≥150 mg/dL; low HDL cholesterol <40 mg/dL in men and <50 mg in women; high blood pressure ≥130/85 mmHg; and high fasting glucose ≥110 mg/dL. Psychiatric diagnosis were done by using DSM-IV with face to face interviews. The Beck Depression Inventory-2 was used to determine the extent of depressive symptoms. Lifestyle variables were also assessed during the interview. All patients underwent a 75 g OGTT following an overnight period of fasting (10 hour minimum) with measurement of metabolic syndrome parameters, fasting plasma glucose, insulin, and C-peptide at fasting.

Of 260 subjects only 150 were eligible and gave informed consent, 85 men and 65 women. The average age of the of the subjects were 57 years of age, average BMI was 27.2 kg/m2 and none of the subjects received psychotropic treatment. Thirty-nine subjects met the metabolic syndrome criteria, 38 subjects had either lifetime or current major depressive disorder (MDD). Forty-eight had some type of anxiety disorder, 8 had PTSD. Twelve subjects were diagnosed with MDD and anxiety disorder.

There was a higher frequency of metabolic syndrome in subjects with current anxiety disorders compared to subjects without anxiety disorders and MDD P < 0.001. The metabolic syndrome was significantly more frequent in subjects with a lifetime history of MDD P < 0.001.

The data indicated that lifetime major depression and current anxiety disorders are independently connected with metabolic syndrome in a population at high risk for type 2 diabetes mellitus. Due to limitations in the study, clear associations to various subtypes or anxiety and metabolic syndromes were unable to be made. The end result is that the data in a high risk group for type 2 diabetes mellitus does reinforce the correlation between depressive disorders and metabolic syndrome, and may show comparable correlation in some anxiety disorders.

Practice Pearls:

  • Screening for depression and anxiety should be recommended to at risk groups for type 2 diabetes mellitus.
  • Patients with diabetes should be regularly monitored and counseled for depression and anxiety disorders.

Kai G. Kahl, Ulrich Schweiger, Christoph Correll, et al. “Depression, anxiety disorders, and metabolic syndrome in a population at risk for type 2 diabetes mellitus”.Brain and Behavior, 2015; 0(0)