Early-Onset Type 2 Diabetes, and Mood, Anxiety, and Stress-Related Disorders

 

Prevalence of type 2 diabetes (T2D) has been on rise for decades, and so is trend for patients getting it at younger age. The earlier onset of T2D is more challenging for patients as well as healthcare providers. The prevalence of psychiatric disorder  is known to be higher in T2D subjects however, its prevalence in early-onset T2D is not well studied. Also T2D and psychiatric illnesses are know to cluster in family and close relatives.

 

In an interesting population-based cohort study  done by Liu et al 1, that  included individuals born in Sweden during 1968–1998. They identified pairs of full siblings, half-siblings, cousins and obtained information on diagnoses of early-onset T2D (< 45 years age) and mood disorders ( unipolar depression/ bipolar disorder), anxiety, and stress-related disorders from the National Patient Register. 

 

In this study over 3 million persons were studied and 0.3% with  early onset  T2D were detected. These individuals had more than 3X higher risks of any psychiatric illness, almost 4X increased unipolar depression/bipolar disorder/anxiety. Relatives of individuals with early onset T2D also had higher overall risks of the psychiatric disorders (up to 1.5 X). 

 

They used quantitative genetic modelling to estimate the contribution of genetic and environmental effects to the co-occurrence of early-onset T2D and psychiatric disorders(conducted for full sibling and maternal half-sibling pairs). Results showed that  all associations were stronger in full siblings than maternal half-siblings, suggesting that genetics plays a role in the shared familial liability. 

 

These findings are consistent with evidence from previous GWAS, which have revealed that shared susceptibility loci  or pleiotropic genes increase risk for both T2D and mood disorders (2). A recent GWAS observed significant genetic correlations between anxiety/stress-related disorders with higher waist-to-hip ratio, high BMI and obesity (3). 

 

This is probably first study that investigated the shared genetic risk between T2D and anxiety and stress-related disorders.

 

These findings are consistent with previous evidences suggest shared physiological mechanisms linking T2D and psychiatric disorders: dysregulation of the hypothalamic-pituitary-adrenal axis leading to  hypercortisolism and disrupted glucose homeostasis, chronic inflammation and  elevated levels of cytokines , leptin-melanocortin pathway ,  critical neuroendocrine regulator of energy homeostasis, and the microbiota-gut-brain axis.

 

Current guidelines also suggests that in a person with early onset T2D special attention to be given to psychological burden (4,5). 

 

This study highlights importance of  making mental health support integral part of multidisciplinary diabetes management (5) and initiating preventive/screening approach in any person with early onset T2D or mood / stress-related disorders. 

 

 

1. Shengxin Liu, Marica Leone, Jonas F. Ludvigsson, Paul Lichtenstein, Soffia Gudbjörnsdottir, Mikael Landén, Sarah E. Bergen, Mark J. Taylor, Henrik Larsson, Ralf Kuja-Halkola, Agnieszka Butwicka; Early-Onset Type 2 Diabetes and Mood, Anxiety, and Stress-Related Disorders: A Genetically Informative Register-Based Cohort Study. Diabetes Care 1 December 2022; 45 (12): 2950–2956.  https://doi.org/10.2337/dc22-1053

2.  AmareAT, Schubert KO, Klingler-Hoffmann M, Cohen-Woods S, Baune BT. 

The genetic overlap between mood disorders and cardiometabolic diseases: a systematic review of genome wide and candidate gene studies. Transl Psychiatry 2017;7:E1007

3. Meier SM, Trontti K, Purves KL, et al. Genetic variants associated with anxiety and stress-related disorders: a genome-wide association study and mouse-model study. JAMA Psychiatry2019;76:924–932

4.  Wong J Ross G,  Zoungas S, et al. Management of type 2 diabetes in young adults aged 18–30 years: ADS/ADEA/APEG consensus statement. Med J Aust 2022;216:422–429

 

5. American Diabetes Association. Facilitating behavior change and well-being to improve health outcomes: Standards of Medical Care in Diabetes—2022. Diabetes Care 2022;45( Suppl. 1): S60–S82

 

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