The relationship between depressive symptoms and glycemic control is stronger in women with type 2 diabetes in South Asians: Results from a cross-sectional multicenter study

Introduction

While the bidirectional relationship between depression and diabetes is well recognized, the outcome of studies evaluating the potential for sex disparity, especially in low-to-middle-income (LMIC) South Asian countries, is unexplored. We evaluated sex differences in the relationship between depressive symptoms and glycemic control in individuals with type 2 diabetes in Bangladesh.

Methods

1,485 unselected individuals with, and 228 without, type 2 diabetes completed the PHQ-9 (depression screening questionnaire), and sociodemographic and clinical data were obtained. The PHQ-9 scores were categorized as mild (5–10), moderate (10–15), moderately severe (15–20), and severe (≥20) depressive symptoms, with scores ≥10 indicating clinically relevant symptoms. Descriptive statistics and ordinal and binary logistic regression analyses were performed.

Results

In individuals with type 2 diabetes, mean HbA1c was 9.8 ± 0.1%, with no difference between sexes (9.9 ± 0.1% vs 9.7 ± 0.2%, P = 0.39). The overall mean PHQ-9 score was 8.5 ± 0.2, with females exhibiting higher scores (9.5 ± 0.2 vs 7.1 ± 0.2, P < 0.001). Depressive symptoms correlated with older age, lower education level, longer diabetes duration (>5 years: OR: 1.5, 95% CI: 1.1–2.3), suboptimal (HbA1c 7–9%: OR: 1.8, 95% CI: 1.1–3.2), and poorer glycemic control (HbA1c ≥9%: OR, 1.7; 95% CI, 1.1–2.9). Suboptimal (OR: 2.2, 95% CI: 1.1–4.3) or poor (OR: 2.5, 95% CI: 1.3–4.9) glycemic control and diabetes duration of 1–5 years (OR: 1.9, 95% CI: 1.2–3.0) and >5 years (OR: 2.4, 95% CI: 1.5–3.9) were associated with an increased likelihood of mild-to-severe depressive symptoms in females, but not in males.

Conclusion

The association of depressive symptoms and poor glycemic control in type 2 diabetes in South Asians is stronger in females.