Depression Increases Risk for Diabetic Macrovascular, Microvascular Complications

Mid adult man doing blood sugar test. Sitting on the floor on exercise mat and measuring blood sugar level after exercise.
The relationship between depression and diabetes complications appears to be bidirectional, although depression was associated with an increased risk for incident macrovascular and microvascular disease.

Depression in people with diabetes is associated with a greater risk for both macrovascular and microvascular complications, according to the results of a meta-analysis published in Diabetic Medicine. The relationship between depression and diabetes complications appears to be bidirectional.

Arie Nouwen, PhD, of Middlesex University, London, United Kingdom, and colleagues searched Embase, Medline, and PsycINFO databases for longitudinal studies assessing the bidirectional association between depression and diabetes macrovascular and microvascular complications. They found 9 studies with comprising more than 1 million participants that examined the relationship between baseline depression and diabetes complications and 2 studies with more than 230,000 participants that explored the relationship between baseline diabetes complications and subsequent depression.

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People with depression have an increased risk of developing diabetes complications; 38% for macrovascular and 33% for microvascular complications. Conversely, the risk of developing depression in people with diabetes is 9% and 24% for macrovascular and microvascular complications, respectively.

Limitations include the small number of studies reviewed, despite the large population size; the high risk for bias as a result of the use of self-report measures in 2 studies; and that the studies did not provide information regarding the specific set of complications that individuals developed.

The investigators concluded that although the relationship between depression and diabetes complications is bidirectional, the risk for diabetes complications in people with depression is higher than the risk for depression in people with diabetes complications.

“It remains to be determined whether effective treatment of depression reduces the risk of developing diabetes complications,” the investigators concluded.


Nouwen A, Adriaanse M, van Dam K, et al. Longitudinal associations between depression and diabetes complications: a systematic review and meta-analysis [published online June 18, 2019]. Diabet Med. doi:10.1111/dme.14054