Risk of Diabetes in Older Adults with Co-Occurring Depressive Symptoms and Cardiometabolic Abnormalities: Prospective Analysis from the English Longitudinal Study of Ageing.

Cassandra Freitas,Bonnie Au,Norbert Schmitz,Kimberley Smith,Sonya Deschênes,Wen-Chih Hank Wu

doi:10.1371/journal.pone.0155741

Abstract

High depressive symptoms and cardiometabolic abnormalities are independently associated with an increased risk of diabetes. The purpose of this study was to assess the association of co-occurring depressive symptoms and cardiometabolic abnormalities on risk of diabetes in a representative sample of the English population aged 50 years and older. Data were from the English Longitudinal Study of Ageing. The sample comprised of 4454 participants without diabetes at baseline. High depressive symptoms were based on a score of 4 or more on the 8-item binary Centre for Epidemiologic Studies–Depression scale. Cardiometabolic abnormalities were defined as 3 or more cardiometabolic risk factors (hypertension, impaired glycemic control, systemic inflammation, low high-density lipoprotein cholesterol, high triglycerides, and central obesity). Cox proportional hazards regressions assessed the association between co-occurring depressive symptoms and cardiometabolic abnormalities with incidence of diabetes. Multiple imputation by chained equations was performed to account for missing data. Covariates included age, sex, education, income, smoking status, physical activity, alcohol consumption, and cardiovascular comorbidity. The follow-up period consisted of 106 months, during which 193 participants reported a diagnosis of diabetes. Diabetes incidence rates were compared across the following four groups: 1) no or low depressive symptoms and no cardiometabolic abnormalities (reference group, n = 2717); 2) high depressive symptoms only (n = 338); 3) cardiometabolic abnormalities only (n = 1180); and 4) high depressive symptoms and cardiometabolic abnormalities (n = 219). Compared to the reference group, the hazard ratio for diabetes was 1.29 (95% CI 0.63, 2.64) for those with high depressive symptoms only, 3.88 (95% CI 2.77, 5.44) for those with cardiometabolic abnormalities only, and 5.56 (95% CI 3.45, 8.94) for those with both high depressive symptoms and cardiometabolic abnormalities, after adjusting for socio-demographic, lifestyle and clinical variables. These findings suggest that those with high depressive symptoms and cardiometabolic abnormalities are at a particularly increased risk of type 2 diabetes.

Highlights

Diabetes is one of the most common chronic diseases in nearly every country, with its global disease burden increasing in numbers and significance [1]
The original English Longitudinal Study of Ageing (ELSA) cohort was drawn from a group of men and women who participated in the Health Survey for England between 1998 and 2001, who were born before March 1, 1952, and who lived in a private household during the first wave of ELSA (2002–2003) [23]
Our prospective analysis demonstrated that those with co-occurring high depressive symptoms and cardiometabolic abnormalities had the highest risk of developing diabetes, and this association remained after adjusting for socio-demographic, lifestyle and clinical factors

Summary

Introduction

Diabetes is one of the most common chronic diseases in nearly every country, with its global disease burden increasing in numbers and significance [1]. According to the International Diabetes Federation (IDF), there are almost 400 million people with diabetes globally, and this number is expected to increase to nearly 600 million by 2035 [2]. The projected increase in prevalence is due in part to increased longevity among people with existing diabetes and an increase in new cases of diabetes due to population ageing, rising levels of obesity and increased physical inactivity [3]. Older adults with diabetes are at an increased risk of mortality, microvascular and cardiovascular complications, higher health care costs and utilisation, sleep and appetite disturbances, reduced social and physical functioning, decreased selfcare management, reduced quality of life, and cognitive decline [8]

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