Predicting type 2 diabetes from concurrent mental disorders: findings from a French cohort study

Abstract Objectives The link between mental and metabolic disorders is understudied. Moreover, mental disorders are typically explored individually, despite high rates of comorbidity. This large prospective study investigated the association of four concurrent mental disorders with incident type 2 diabetes (T2D) in adults recruited from the general population. Methods Adults without prevalent diabetes enrolled in the French NutriNet-Sante cohort who had completed the trait anxiety subscale of the Spielberger State-Trait Anxiety Inventory (STAI-T 2013-2016), the Center for Epidemiologic Studies Depression Scale (CES-D 2013, 2015), the Sick-Control-One-Fat-Food scale (SCOFF 2014) and a sleep questionnaire (2014) were eligible for analysis. A working group of physicians defined incident T2D cases (occurring through March 2024), cross-referencing self-reported diagnosis or treatment with the national health insurance database. Multivariable PLS-Cox models were used to investigate the association between specific mental health profiles and T2D incidence. Results The study sample included 29,332 participants [75.0% women, mean age = 53.4 (13.8) years]. During a mean follow-up of 7.2 years, there were 430 (1.5%) incident T2D cases. The baseline prevalence of each mental health condition was higher among adults who developed T2D versus their diabetes-free counterparts. Two mental health profiles (or latent components) were identified, of which only one remained significantly associated with T2D risk in fully-adjusted analyses (HR = 1.13, 95% CI: 1.06-1.21, p < 0.001). That profile was underscored by concurrent trait anxiety, depressive symptoms and an eating disorder. Conclusions Given the growing prevalence of mental disorders and T2D in the general population, the results highlight the urgent need for prevention that addresses mental disorders before they lead to deleterious metabolic consequences. The findings likewise advance mental-physical multimorbidity research. Key messages • Comorbidity of mental health conditions is not uncommon in the general population. • Clusters of mental health conditions can predict incident type 2 diabetes in adults.