Prevalence of Depression and Anxiety in Patients with Type 2 Diabetes Mellitus and Their Association with Glycemic Control: A Cross-Sectional Study: Depression, Anxiety, and Glycemic Control in Type 2 Diabetes

Maryam  Gulzar; Saleha  Saboor; Syed Hasnain  Abbas; Afrasiab  Anser

doi:10.69750/dmls.02.08.0148

Authors

Maryam Gulzar Hungarian University of Agriculture and Life Sciences (MATE), Budapest, Hungary Author
Saleha Saboor Lecturer, National University of Modern Languages (NUML), Islamabad, Pakistan Author
Syed Hasnain Abbas National University of Modern Languages (NUML), Islamabad, Pakistan Author
Afrasiab Anser Department of Psychology, National University of Modern Languages (NUML), Islamabad, Pakistan Author

DOI:

https://doi.org/10.69750/dmls.02.08.0148

Keywords:

Type 2 diabetes, depression, anxiety, glycemic control, HbA1c

Abstract

Background: Depression and anxiety are common yet underrecognized comorbidities in patients with type 2 diabetes mellitus (T2DM). Both conditions may adversely influence self-management and contribute to poor glycemic outcomes, but local data from South Asia remain limited.

Objective: To determine the prevalence of depression and anxiety in adults with T2DM and examine their association with glycemic control.

Methods: A cross-sectional study was conducted among 90 adults with T2DM attending two tertiary care hospitals in Punjab, Pakistan. Depression and anxiety were assessed using validated Urdu/English versions of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7). Glycemic control was indexed by glycated hemoglobin (HbA1c), measured with NGSP-certified assays. Logistic and linear regression models evaluated associations between psychological morbidity and HbA1c, adjusting for demographic and clinical covariates.

Results: The mean age of participants was 54.8 ± 10.2 years; 47.8% were male. Mean diabetes duration was 9 years (IQR 5–13). Moderate-to-severe depressive symptoms were present in 31.1% and clinically significant anxiety in 27.8%; 17.8% had both conditions. Diabetes distress was reported by 36.7%. Participants with depression had significantly higher HbA1c than those without (8.5 ± 1.3% vs. 7.6 ± 1.3%; p<0.001). Anxiety was similarly associated (8.4 ± 1.2% vs. 7.6 ± 1.4%; p=0.003). In adjusted models, depression remained independently linked to higher HbA1c (β=+0.32%, p=0.002), and screen-positive depression doubled the odds of poor glycemic control (OR=2.41, 95% CI 1.03–5.61).

Conclusion: Depression and anxiety are prevalent among Pakistani adults with T2DM and strongly correlate with poor glycemic control. Integrating routine mental health screening and multidisciplinary interventions into diabetes care could improve both psychological well-being and metabolic outcomes.

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References

Fanelli G, Raschi E, Hafez G, Matura S, Schiweck C, Poluzzi E, et al. The interface of depression and diabetes: treatment considerations. Transl Psychiatry. 2025;15:67. doi:10.1038/s41398-025-03234-5.

Ajele KW, Okoro EO, Balogun WM, Adeyemi AO. The role of depression and diabetes distress in glycemic control and self-care behaviours among adults with type 2 diabetes. Diabet Res Clin Pract. 2025;212:111249. doi:10.1016/j.diabres.2025.111249.

Zheng C, Yu J, Liu Y, Wang X, He J, Chen H, et al. Association between depression severity and diabetes incidence and biomarkers: NHANES analysis. Sci Rep. 2024;14:13569. doi:10.1038/s41598-024-78345-y.

Liu Y, Zhou J, Zhang Y, Sun R, Chen W. Bidirectional relationship between diabetes mellitus and depression: evidence from human and animal studies. Front Endocrinol (Lausanne). 2024;15:11514559. doi:10.3389/fendo.2024.11514559.

Khawagi WY, Al-Harbi AM, Elmahdy M, AlQahtani N, Alrashidi M. Depression and type 2 diabetes: a causal relationship and its implications. Diabetes Obes Metab. 2024;26(7):1506–15. doi:10.1111/dom.15630.

Koyama AK, Hora IA, Bullard KM, Benoit SR, Tang S, Cho P, et al. State-specific prevalence of depression among adults with and without diabetes—United States, 2011–2019. Prev Chronic Dis. 2023;20:E24. doi:10.5888/pcd20.220407.

Venkatesan A, Ghosh S, Patel N, Williams K, Chen X. Improvements in glycemic control and depressive symptoms in participants of a digital health program. JMIR Form Res. 2023;7(1):e41880. doi:10.2196/41880.

Yang W, Liu M, Tian Y, Zhang Q, Zhang J, Chen Q, et al. The increased prevalence of depression and anxiety in T2DM patients associated with blood glucose fluctuation and sleep quality. BMC Endocr Disord. 2022;22:232. doi:10.1186/s12902-022-01147-8.

Hargittay C, Hajos TRS, Pinter E, Jermendy G, Hidvégi T. Severity of depressive but not anxiety symptoms impacts glycemic control in type 2 diabetes. Front Med (Lausanne). 2022;9:944047. doi:10.3389/fmed.2022.944047.

Kintzoglanakis K, Mastrogianni A, Pappas E, Tsiamita M, Papadopoulos A. Depression, anxiety, and diabetes-related distress in type 2 diabetes: associations and outcomes. SAGE Open Med. 2022;10:20503121221096605. doi:10.1177/20503121221096605.

AlOzairi M, Ismail K, Winkley K. Prevalence and predictors of diabetes distress in people with diabetes. Front Psychiatry. 2024;15:1367876. doi:10.3389/fpsyt.2024.1367876.

Déniz-García A, Rojas R, Álvarez A, Martín-Pérez M, Rodríguez C. Impact of anxiety, depression and disease-related distress on long-term glycaemic variability in diabetes. BMC Endocr Disord. 2022;22:122. doi:10.1186/s12902-022-01013-7.

Deischinger C, Dervic E, Leutner M, Klimek P, Kautzky A, Kautzky-Willer A. Diabetes mellitus is associated with higher risk for major depressive disorder: a nationwide cohort study. BMJ Open Diabetes Res Care. 2020;8(1):e001430. doi:10.1136/bmjdrc-2020-001430.

Holt RI, de Groot M, Golden SH. High prevalence of depressive symptoms in patients with diabetes. Diabetes Care. 2021;44(5):1100–7. doi:10.2337/dc20-1637.

Ayele B, Alemayehu T, Zewdu T. Depression increases risk of cardiometabolic diseases, including type 2 diabetes. Diabetes Obes Metab. 2024;26(8):1610–20. doi:10.1111/dom.15630.

Pardhan S, Mahomed N, Soni H, Shaheen A. Investigating the prevalence and associated factors of mental-health conditions in people with diabetes. Sci Rep. 2024;14:21915. doi:10.1038/s41598-024-75144-3.

Busili A, Rossi S, Angelini A, Scardovi A. Risk factors for mental-health disorders in patients with T2DM: a review. Medicina (Kaunas). 2024;60(5):760. doi:10.3390/medicina60050760.

Dhingra R, Kumar S, Bhandari M. Moderate-to-severe depression symptoms are associated with poor glycemic control in adults with diabetes. Prim Care Diabetes. 2025;19(1):34–42. doi:10.1016/j.pcd.2025.01.007.

Nguyen KA, Wong E, Lee J, Tan V. Association of depression with glycaemic control in people with diabetes: a population-based study. BMJ Open Diabetes Res Care. 2025;13:e004567. doi:10.1136/bmjdrc-2024-004567.

Oyeleye-Adegbite OC, Brown AF, Quiñones AR. Antidepressant use and HbA1c among US adults with type 2 diabetes and depression. BMC Endocr Disord. 2025;25:145. doi:10.1186/s12902-025-01745-9.

Albai O, Sima A, Sima L, Bolos C. Predictive factors of anxiety and depression in patients with type 2 diabetes. Healthcare (Basel). 2024;12(5):562. doi:10.3390/healthcare12050562.

Liu X, Li S, Xu Q, Zhou L. Prevalence of depression in patients with type 2 diabetes in China: a systematic review and meta-analysis. Front Med (Lausanne). 2022;9:759499. doi:10.3389/fmed.2022.759499.

Fatima M, Khan M, Javed S. Evidence-based prevalence of diabetes-related depression and anxiety: a cross-sectional study. Cureus. 2025;17(1):e78945. doi:10.7759/cureus.78945.

CDC. Diabetes distress among US adults with diagnosed diabetes—BRFSS 2021. Prev Chronic Dis. 2025;22:E20. doi:10.5888/pcd22.240287.

International Diabetes Federation. IDF Diabetes Atlas. 11th ed. Brussels: IDF; 2025. doi:10.1016/B978-0-323-52907-0.00001-3.