Support for anxiety screening in people with prediabetes
medwireNews: Symptoms of anxiety are associated with an increased risk for progression from prediabetes to type 2 diabetes, indicate findings from a population-based study.
Therefore, anxiety “should be routinely considered alongside the traditional risk factors in people with prediabetes,” say Karl-Heinz Ladwig (German Research Center for Environmental Health, Neuherberg) and co-researchers.
The team analyzed data from 1708 people free from diabetes at baseline, of whom 14.5% had prediabetes and 6.7% had anxiety. Prediabetes was defined as fasting plasma glucose of 42–48 mmol/mol (6.0–6.5%) and/or impaired glucose tolerance after an oral glucose tolerance test, while anxiety was measured by the generalized anxiety disorder (GAD)-7 questionnaire.
In all, 6.6% of participants were diagnosed with type 2 diabetes over an average 6.5 years of follow-up. Of these 112 individuals, 68.8% had prediabetes at baseline, which the researchers say equates to an average annual diabetes progression rate of 5.0%.
Among people with prediabetes, those with high anxiety (GAD-7 >10 points) had a significant 3.06-fold higher risk for progression to type 2 diabetes than those with low anxiety after adjustment for age and sex. However, this association lost statistical significance after additional adjustment for lifestyle and metabolic factors, and was further attenuated when depression was added to the model.
Individually, prediabetes (adjusted odds ratio [OR]=10.76) and anxiety (OR=2.89) were each associated with a significantly elevated risk for type 2 diabetes. When patients with both conditions were compared with those without either, individuals with anxiety and prediabetes had an almost 21-fold increased risk for developing type 2 diabetes.
Finally, the team demonstrated that the interaction between prediabetes and anxiety accounted for a significant proportion of diabetes risk, with an attributable risk proportion of 0.52 (where values >0 indicate an additive effect of anxiety in people with prediabetes).
In light of these findings, “[p]hysicians are advised to additionally screen for anxiety when treating high risk [prediabetes] patients with an adverse risk factor profile,” write Ladwig and colleagues in Diabetic Medicine.
“Further research into the underlying mechanisms and the effectiveness of mental health interventions among high risk populations are urgently needed,” they conclude.
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