Poor glycemic control and microvascular complications: key drivers of depressive symptoms in adults with diabetes

To analyze the association between depressive symptoms and diabetes complications, stratified by metabolic control, in Mexican adults with type 2 diabetes mellitus.

We analyzed data from adults aged 20 years and older with self-reported diabetes from the 2018-2019 Mexican National Health and Nutrition Survey (ENSANUT). Diabetes complications were categorized as microvascular, macrovascular, or other. Metabolic control was defined based on glycated hemoglobin, blood pressure, and cholesterol levels. Depressive symptoms were assessed using the CES-D7 scale. Logistic regression models were stratified by metabolic control to determine the association between complications and depressive symptoms, adjusting for relevant covariates.

Among adults with poor metabolic control, depressive symptoms were significantly more prevalent in those with complications (47.2%, 95% CI: 46.4-53.9) than in those without (27.9%, 95% CI: 24.4-31.7). Among individuals with good metabolic control, the prevalence of depressive symptoms was higher in those with complications (48.8%, 95% CI: 34.6-63.2) than in those without (31.3%, 95% CI: 23.6-40.2), although the difference was not statistically significant. In those with poor metabolic control, both microvascular and other complications were significantly associated with depressive symptoms (adjusted odds ratios [_adjOR] 2.3 [1.6-3.5] and 2.3 [1.4-3.7], respectively).

Poor metabolic control is associated with a higher prevalence of depressive symptoms, especially in patients with microvascular complications. These findings highlight the importance of integrating mental health screening and intervention into diabetes care to support emotional well-being and prevent adverse outcomes.