Eight-year nationwide study of the bidirectional association between type 2 diabetes and depression in nearly 8 million German outpatients
Authors' conclusion
Our findings confirm a bidirectional link between type 2 diabetes and depression, particularly in younger individuals. As type 2 diabetes and depression are frequent, future research needs to study whether preventive approaches can reduce the risk of developing this comorbidity.
Study context
- Population
- German nationwide outpatients, claims data 2012–2022, newly diagnosed with T2D or depression in 2015matched cohort
- Exposure
- Newly diagnosed T2D vs matched controls (depression risk); newly diagnosed depression vs matched controls (T2D risk)
- T2Dn = 294,642
- Depressionn = 1,271,537
- Outcome
- Bidirectional risk: depression after new T2D diagnosis and T2D after new depression diagnosis
- Follow-up
- 8 years
Methodological detailsnationwide outpatient claims data, matched 1:4 to controls by age, sex and region, mixed-effects Cox proportional hazards models
- Nationwide outpatient claims data
- Matched 1:4 to controls by age, sex and region
- Mixed-effects Cox proportional hazards models
Main finding
As reported in the abstract
Depression after T2D; T2D after depression
Each group vs controlsHazard ratio (99% CI)
T2Ddepression risk; N=54 561 with depression; adjusted for Charlson Comorbidity Index, urbanicity, area-level deprivation
1.23(1.21–1.24)
DepressionT2D risk; N=71 848 with T2D; adjusted for Charlson Comorbidity Index, urbanicity, area-level deprivation
1.15(1.14–1.17)
Observational data: associations, not effects.
Further findings
Age subgroups
- Association between depression and T2D stronger in younger age groups, especially under 34 years
Sex-stratified analyses
- Findings held across sex-stratified analyses
Time-stratified analyses
- T2D–depression association more pronounced in earlier follow-up quarters; T2D risk after depression constant throughout follow-up
Original publication
Eight-year nationwide study of the bidirectional association between type 2 diabetes and depression in nearly 8 million German outpatients. BMJ Open Diabetes Res Care. Published 7 May 2024. doi:10.
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