Depression is a common mental illness. Its main characteristics include low mood, reduced interest, pessimism, slow thinking, lack of initiative, self-blame, poor diet, and sleep, worry about suffering from various diseases, and feeling that the whole body is tired. Feeling unwell, and in severe cases, suicidal thoughts and behaviors may occur. Maina et al. [5]reported that there is a causal relationship and a positive correlation between depression and type 2 diabetes. Prediabetes is a state in which blood sugar levels have increased but have not yet reached the diagnostic criteria for diabetes. During this stage, an individual's risk of developing diabetes increases. To explore this relationship further, our study aimed to examine the relationship between depression and prediabetes.
The results of this study indicate that moderate to severe depression is significantly associated with the development of prediabetes. Similarly, there may be a bidirectional relationship between prediabetes and anxiety and depression, that is, when a patient is diagnosed with prediabetes, it can aggravate the occurrence of anxiety and depression, and anxiety and depression can accelerate the risk of prediabetes converting into diabetes. [6]
Zhou, Lu [7–9], and others reported that the incidence of anxiety and depression in patients with prediabetes is higher than that in the normal population. As early as 2016, Liu et al.[10] established a one-year China Health and Retirement Longitudinal Study (CHARLS), which included Chinese elderly with known or unknown diabetes. Participants with newly diagnosed diabetes or prediabetes were considered to have unknown diabetes. Findings showed that knowledge of having diabetes, treatment, and other chronic conditions was associated with higher rates of depression in patients with known diabetes compared with those with unknown diabetes. The prevention of depression in patients with diabetes should receive more attention among middle-aged, female, and less educated people. Some of the findings are similar to ours in that we used the PHQ-9 criterion to stratify depressive status, which significantly contributes to the development of depression. Therefore, large prospective studies are still needed to study the impact of depression on the development and prognosis of prediabetes.
Multiple previous studies have shown [11–13] that major depression is significantly associated with mortality in type 2 diabetes. In our study, moderate to severe depression was found to be positively associated with all-cause mortality in patients with prediabetes. Increased hypothalamic-pituitary-adrenal (HPA) axis activity has been implicated in the pathophysiology of depression and anxiety, leading to the development of some metabolic precursors of type 2 diabetes (e.g., insulin resistance, hypertension, and visceral obesity) through increased cortisol exposure. Likewise, inflammatory markers and activation of the immune system are also thought to be links between depression and the development of diabetes. Depression is associated with the activation of several relevant biological systems, including the HPA axis, the sympathetic nervous system, and the inflammatory response, which can influence insulin resistance and glycemic outcomes. Further confounding the relationship between depression, anxiety, and the transition from prediabetes to type 2 diabetes. Medications used to treat these mental health disorders are associated with an increased risk of type 2 diabetes. Early screening and early intervention for patients taking these medications can significantly reduce the risk of prediabetes. Patient mortality. [14, 15]
Recently, a genetic study used genetic correlation analysis, multigene overlap analysis, and Mendelian randomization analysis to confirm the intrinsic link between type 2 diabetes and attention deficit hyperactivity disorder. [16]In the study, genetic correlation analysis showed that type 2 diabetes and attention deficit hyperactivity disorder showed a significant positive correlation in two gene sets (ADHD2019 and ADHD2022). Multigene overlap analysis showed that in the ADHD2022 gene set, type 2 diabetes and attention deficit hyperactivity disorder share the vast majority (90%) of risk variant genes, and Mendelian randomization analysis showed that in the ADHD2019 gene set, attention deficit hyperactivity disorder There is a genetic bidirectional causal relationship between ADHD and type 2 diabetes. The research results of Wang[17] also proved that adults with a history of attention deficit hyperactivity disorder are strongly related to the occurrence of depression and alcoholism. Therefore, depression and attention deficit symptoms may be related to biology, metabolism, and life. It is related to many risk factors such as lifestyle, which lead to the progression of prediabetes to type 2 diabetes.
Clinical significance
Early diagnosis and intervention of prediabetes are of great significance in preventing diabetic transformation and complications. Currently, the first-line treatment for prediabetes is lifestyle modification or metformin. Intensive lifestyle modifications such as diet, exercise, and weight loss are more beneficial than metformin use. However, there are currently no effective ways to reduce the incidence of prediabetes. We provide further valuable insights into elucidating the relationship between depression and prediabetes. Due to the fast pace of modern work and the high pressure in people's lives, depression has become a relatively common mental illness. Our research report provides a new insight into the risk and treatment of prediabetes from the perspective of mental health conditions. Endocrinologists should focus on the mental health of patients with prediabetes, not just those with diabetes. Endocrinologists should not only pay attention to patients' mental health status during diabetes treatment but also pay attention to preventing the development and worsening of prediabetes by paying attention to mental health status. Future research is warranted to investigate whether therapeutic interventions aimed at addressing mental health can reverse or impede the progression from prediabetes to diabetes, thereby preventing subsequent negative health outcomes.