Type 2 diabetes, sleep disorders linked to increased risk for depression
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Adults with type 2 diabetes or a sleep disorder have an increased risk for depression compared with those with neither condition, according to data published in the Journal of Diabetes and Its Complications.
In analysis of data from population-based registries in Denmark, type 2 diabetes and a sleep disorder were identified as independent risk factors for depression, and those with both conditions also had increased risk for depression.
“Sleep disorders did not explain the association between type 2 diabetes and depression but were an independent risk factor for depression,” Ida Kim Wium-Andersen, MD, a resident at Psychiatric Center Copenhagen in Denmark, and colleagues wrote. “Furthermore, sleep and diabetes had antagonistic effect on depression risks, meaning that the joint effect of sleep disorder and diabetes was lower than what would be expected given the separate risk of diabetes and sleep disorder.”
Researchers conducted a population-based cohort study of 115,807 adults with type 2 diabetes aged 40 years and older registered in the Danish National Diabetes Register from 2000 to 2012. The diabetes group was matched with a reference group of 116,682 adults without diabetes with data available in Denmark’s Civil Registration System. Depression was identified through depression-related hospitalization in the Danish National Patient Registry or record of any filled antidepressant prescription in the Danish National Prescription Registry. Sleep disorders were defined through any hospital-based sleep disorder diagnosis or at least two filled sleep medication prescriptions.
Of the full study cohort, 2.6% were diagnosed with depression during follow-up, 32.1% redeemed at least one antidepressant medication, 15.3% redeemed at least two sleep medication prescriptions and 1% had a sleep disorder diagnosis. When categorized by both diabetes and sleep disorders, 43.2% had neither condition, 41.6% had diabetes but no sleep disorder, 7% had only a sleep disorder and 8.3% had diabetes and a sleep disorder.
“Patients with diabetes more often had a prior sleep disorder than individuals without diabetes,” the researchers wrote. “An explanation could be that patients at the time of diabetes diagnosis have had undiagnosed diabetes for several years due to asymptomatic diabetes or not recognizing their symptoms as symptoms of diabetes.”
After adjusting for sleep disorders and potential confounders, adults with diabetes were more likely to be diagnosed with depression (adjusted HR = 1.19; 95% CI, 1.12-1.26) and to redeem an antidepressant medication (aHR = 1.27; 95% CI, 1.26-1.29) than those without diabetes.
Compared with adults without diabetes and a sleep disorder, the risk for diagnosed depression was increased for adults with type 2 diabetes only (aHR = 1.27; 95% CI, 1.19-1.35), those with a sleep disorder only (aHR = 1.46; 95% CI, 1.33-1.59) and adults with type 2 diabetes and a sleep disorder (aHR = 1.49; 95% CI, 1.37-1.63). The results were similar when examining associations with antidepressant medication use.
When participants were divided into groups younger and older than 60 years, those younger than 60 years with diabetes and a sleep disorder had a slightly higher risk for depression than those aged 60 years and older. However, sleep disorders did not explain the association with depression in either age group.
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