Diabetes Linked to Eating Disorders and Depression

Depressed woman looking at foodDepression and impulse control disorders (eating disorders in particular) are independently associated with diagnosis of type 2 diabetes, according to a cross-sectional survey of adults published online ahead of print in Diabetologia.

These findings are of interest because depression and impulse control disorders like eating disorders have an earlier age of onset compared with type 2 diabetes; thus, the findings suggest “a window of opportunity for prevention of diabetes by targeting these psychiatric disorders,” said lead author Peter de Jonge, PhD, Professor of Psychiatric Epidemiology, Interdisciplinary Center for Psychopathology and Emotion Regulation, University Medical Center Groningen, Netherlands.

Metabolic Dysregulation Could Underlie the Associations
While it is unclear at this time whether improved treatment of these psychiatric disorders can help prevent diabetes, “it seems to be a plausible association,” Dr. de Jonge said. “What I find fascinating about our results is that another explanation is also possible, namely that depression and impulse control disorders might be early signs of metabolic dysregulation. If this is true, it would seem to be important that children learn early in life to adopt healthy eating behaviors with particular interest in a low sugar diet,” Dr. de Jonge said.

While previous studies have explored the associations between diabetes and depression, these studies have a variety of limitations and have not assessed for other mental disorders. Thus, the authors used data from World Mental Health Surveys to examine the associations between 16 mental disorders and diabetes diagnosis among 52,095 participants in 19 countries.

The authors identified 2,580 cases of adult-onset diabetes. Initially, all 16 mood disorders were associated with diabetes diagnosis. However, in multivariate analysis that adjusted for confounding factors, only depression (odds ratio [OR], 1.30) intermittent explosive disorder (OR, 1.6), binge eating disorder (OR, 2.6) and bulimia nervosa (OR, 2.1) were independently associated with an increased risk of diabetes diagnosis. While the association between depression and diabetes is within the range reported in other meta-analyses, the authors noted the association between impulse control disorders (including eating disorders) and diabetes has not been reported before.

Other Potential Mechanisms Behind the Diabetes­–Depression Association
“The diagnosis of depression covers an extremely wide range of different psychopathological conditions, and depressive symptoms may be present as a comorbidity of almost all psychiatric disorder,” commented Francesco Rotella, MD, PhD, Research Fellow, Careggi Teaching Hospital and University of Florence, Florence, Italy.

“There are many possible confounders that could interfere with the association of depression with diabetes. However, the most recent meta-analyses of longitudinal studies confirm that depression is a risk factor for incident diabetes even after adjusting for some well-established confounding factors (eg, antidepressant drugs use or overweight/obesity),” Dr. Rotella said. “This suggests that the association of depression with diabetes is at least partly due to other mechanisms. Given the lower rates of incidence and prevalence of intermittent explosive disorder, binge eating disorder, and bulimia nervosa, it is not possible at the moment to perform the same analyses for these disorders,” he said.

“Other potential mechanisms that can be involved in the association between depression and diabetes may include hyperactivity of stress-related hormonal systems and hyperproduction of pro-inflammatory cytokines,” Dr. Rotella said. “However, alterations of hypothalamic-pituitary-adrenal axis have been observed in almost all psychiatric disorders, including some that have never been associated with diabetes. This topic is definitely of great interest, but we must be aware that it leads us to investigate a longstanding problem: the interface between mind and body,” he concluded.

de Jonge P, Alonso J, Stein DJ, et al. Associations between DSM-IV mental disorders and diabetes mellitus: a role for impulse control disorders and depression. Diabetologia. 2014. [Epub ahead of print]

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