Risk of Developing Type 2 Diabetes in Individuals With a Psychiatric Disorder: A Nationwide Register-Based Cohort Study

Abstract

OBJECTIVE Previous studies have investigated the incidence of type 2 diabetes in individuals with psychiatric disorders, but most studies have focused on a specific psychiatric disorder or a selected sample. More population-based studies are needed to determine these associations in representative samples. We therefore aimed to determine these associations in a nationwide, register-based dynamic cohort study. RESEARCH DESIGN AND METHODS We analyzed data from 5,005,612 adults living in Denmark between 1995 and 2018, without prior diabetes. We investigated 10 different categories of psychiatric disorders and a composite group with any psychiatric disorder. Individuals with a psychiatric disorder were compared with individuals without using multivariable-adjusted Poisson regression to estimate incidence rate ratios (IRR) of type 2 diabetes. We modeled age-specific incidence rates (IR) for individuals with and without the specific psychiatric disorder. All models were stratified by sex. RESULTS In total, 334,739 individuals developed type 2 diabetes during follow-up. For all investigated categories of psychiatric disorders, we found increased IR of type 2 diabetes for individuals with versus those without a psychiatric disorder (IRR: men, 1.47 [95% CI 1.45–1.50]; women, 1.65 [95% CI 1.62–1.68]). When we examined age-specific IR, the largest differences were found in the younger population (<50 years). CONCLUSIONS We found that the IR of type 2 diabetes was higher in individuals with a psychiatric disorder compared with individuals without a psychiatric disorder and particularly high in the younger people with a psychiatric disorder. New studies into the prevention and early detection of type 2 diabetes in these groups are warranted.

Temporally ordered associations between type 2 diabetes and brain disorders – a Danish register-based cohort study

“…For the association of psychiatric disorders and subsequent T2DM, our results replicate previous findings of increased risk of T2DM in individuals with psychiatric disorders, including substance use disorder, schizophrenia, depression, bipolar disorder, personality disorder, and ADHD, all with similar effect sizes as ours, despite a younger cohort in our study and differences in T2DM definitions [13,14,17,41]. Our study also adds to the literature by demonstrating significant positive associations of other specific psychiatric disorders, namely OCD, ASD, other (non-anorectic) eating disorders, and anxiety, with subsequent diagnoses of T2DM.…”

“…Across the lifespan, T2DM is associated with increased risks for adverse health outcomes, such as cardiovascular diseases, and premature death [7][8][9]. Studies have also found associations between T2DM and disorders of the brain, including vascular dementia and Alzheimer's disease [10], substance use disorder, schizophrenia, bipolar disorder, depression, personality disorder, and attention-deficit/ hyperactivity disorder (ADHD) [11][12][13][14][15][16][17], obsessive-compulsive disorder (OCD) [18], cognitive impairment [19], and also of filling a prescription for psychotropic drugs, including antidepressants, antipsychotics, and anxiolytics [20]. Recently, the term "insulinopathies of the brain" has been suggested to characterize these associations between T2DM and brain disorders [21,22].…”

“…If an association is bi-directional, with comparable incidence rates of the brain disorder before and after T2DM, this may suggest that both disorders serve as independent risk factors for the onset of each other, or that the association is mainly driven by shared risk factors [24], such as unhealthy lifestyles [25] and common genetic risks [26,27]. Previous studies have also suggested sex differences in the association between T2DM and brain disorders, though findings have been mixed [14,28,29], and more data on this is needed. In this study, we will add new knowledge on the sex-specific temporally ordered associations between T2DM and brain disorders.…”

Temporal trends in the prevalence and incidence of depression and the interplay of comorbidities in patients with young- and usual-onset type 2 diabetes from the USA and the UK

“…More research is required to understand the dynamics and patterns of management of patients with depression to improve outcomes for patients with diabetes and other comorbidities including depression. In addition, given the complexity of the roles of comorbidities in the interplay of diabetes and depression, detailed evaluation of the bidirectional association between these conditions in different ethnicities, age groups and sex is crucial [ 32 ].…”

Living With Type 2 Diabetes

“…[1][2][3] The causes of T2DM are complex and socially mediated, with risk factors including but not limited to: being older; having a family history of or genetic predisposition to T2DM; being of Indigenous, African, Arab, Hispanic, or South Asian descent; living with overweight or obesity; being physically inactive; having a lower level of education or socioeconomic status; having an unhealthy diet; living with psychological stress, mental illness, or social isolation; and exposure to air and noise pollution. 1,[4][5][6][7][8][9][10] Persistent hyperglycemia may cause short-and long-term complications associated with decreased quality of life and, in some cases, early death. [11][12][13][14] In the short term, hyperglycemia can cause excessive urination, thirst, weight loss, increased risk of infection, and neurologic symptoms.…”