(DCP039) ELEVATED ANXIETY AND THE RISK OF DIABETES COMPLICATIONS IN ADULTS WITH TYPE 2 DIABETES FROM QUEBEC, CANADA

Background: While psychological factors such as depression are associated with an increased risk of diabetes complications, the role of anxiety symptoms in the risk of diabetes complications is unclear. This study examined the prospective associations between anxiety symptom scores and the likelihood of developing micro- and macrovascular complications in adults with type 2 diabetes.

METHODS AND RESULTS: Data were from the CARTaGENE Study in Quebec, Canada. Baseline recruitment was conducted in two phases (Phase A conducted in 2009-2010; Phase B in 2012-2015). Anxiety symptoms were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale (range=0-21). A follow-up interview was conducted in 2017 with a subset of Phase A and Phase B CARTaGENE participants with type 2 diabetes (N=567; mean age 59 (SD=7; range=40-70) years; 37% female). Diabetes complications were assessed using the Diabetes Complications Index, administered via telephone interview during the follow-up assessment. Logistic regressions examined associations between anxiety at baseline and newly developed complications at follow-up. In a second set of analyses, sociodemographic (age, sex, race/ethnicity, education, and marital status) and lifestyle/health characteristics (smoking, physical activity, diabetes duration) were included as covariates. Elevated symptoms of depression, assessed with the Patient Health Questionnaire-9 (PHQ-9; range 0-27), was examined as an additional covariate in a third set of analyses.
154 (27%) participants developed diabetes complications during the follow-up period. Continuous anxiety symptom scores were associated with an increased likelihood of developing complications (OR = 1.09, 95% CI = 1.04, 1.14) during a mean follow-up period of 5.6 (SD=1.8) years. While this association remained after accounting for sociodemographic and lifestyle factors (OR = 1.11, 95% CI = 1.05, 1.17), anxiety was no longer a significant predictor of complications when additionally adjusting for depression (OR = 1.01, 95% CI = 0.94, 1.10). Continuous depressive symptom scores were associated with incident diabetes complications (OR = 1.12, 95% CI = 1.04, 1.20).

Conclusion: Elevated anxiety is associated with a heightened risk of diabetes complications, independently of sociodemographic and lifestyle factors, with every one-unit increase in anxiety symptom scores associated with an 11% increased risk of complications. However, this association may be due to overlap with depressive symptoms. Notably, few participants had anxiety scores on the high end of the continuum. Identifying and addressing affective symptoms in adults with type 2 diabetes may be an important avenue for the prevention of diabetes complications, but more research is needed to determine the independent roles of depressive and anxiety symptoms.