High Depressive Symptoms in Previously Undetected Diabetes – 10-Year Follow-Up Results of the Heinz Nixdorf Recall Study

Figures & data

Figure 1 Flow chart: overview of participant selection criteria for study populations.

Table 1 Baseline Participant Characteristics, Stratified by Diabetes Status

	Diagnosed Diabetes	Undetected Diabetes	No Diabetes
	(n=201)	(n=158)	(n=2454)
Age, mean (SD), y	61.1 (7.4)	60.3 (7.5)	58.6 (7.6)
Male (%)	65.7	72.8	50.6
Education: years of school % (95%-CI)^a
≤10	11.4 (7.4–16.7)	8.2 (4.5–13.7)	8.5 (7.5–9.7)
11–13	54.7 (47.6–61.7)	55.7 (47.6–63.6)	55.2 (53.2–57.2)
14–17	23.9 (18.2–30.4)	28.5 (21.6–36.2)	23.8 (22.1–25.5)
≥18 years	10.0 (6.2–14.9)	7.6 (4.0–12.9)	12.5 (11.2–13.9)
No regular physical exercise % (95%-CI)	54.7 (47.6–61.7)	58.2 (50.1–66.0)	44.4 (42.4–46.4)
BMI, mean (SD), (kg/m^2)^b	30.1 (5.1)	30.6 (5.2)	27.3 (4.2)
BMI >30 kg/m^2(95%-CI)(%)^b	43.0 (36.0–50.2)	51.0 (42.9–59.0)	21.0 (19.4–22.7)
HbA1c (mean, SD) (%)^c	7.0 (1.3)	6.3 (1.6)	5.3 (0.5)
CRP, median (quartiles)^d	0.20 (0.08–0.43)	0.17 (0.09–0.36)	0.13 (0.07–0.28)
Adiponectin, median (quartiles)^e	6135 (4147–10,148)	5390 (3471–8394)	8201(5532–12,373)
Smoking: % (95%-CI)^f
Former smoker	41.8 (34.9–48.9)	43.7 (35.8–51.8)	35.5 (33.6–37.4)
Current smoker	21.9 (16.4–28.3)	25.9 (19.3–33.5)	21.8 (20.2–23.5)
Comorbidities % (95%-CI)
CVD	14.4 (9.9–20.1)	10.1 (5.9–15.9)	4.5 (3.7–5.4)
Myocardial infarction^g	9.0 (5.4–13.9)	7.7 (4.0–13.1)	3.1 (2.4–3.8)
Stroke^h	8.0 (4.6–12.7)	1.3 (0.2–4.5)	1.5 (1.0–2.0)
Participation at 2nd Follow-Up after 10 yrs % (95%-CI)	64.7 (57.6–71.3)	63.9 (55.9–71.4)	77.5 (75.8–79.2)
Diabetes duration, mean (SD), y^i	9.8 (11.5)
Diabetes-related comorbidities % (95%-CI)
Retinopathy^j	10.6 (6.6–15.9)
Blindness^k	0.5 (0.0–2.9)
Proteinuria^l	17.4 (11.7–24.5)
Renal failure^m	2.1 (0.6–5.2)
Renal replacement therapy^n	1.0 (0.1–3.7)
Neuropathy^o	31.6 (25.0–38.7)
Amputation^p	2.1 (0.6–5.2)

Notes: Number of Missing: ^aeducation 4; ^bBMI 13; ^cHbA1c 29; ^dCRP 12; ^eadiponectin 12; ^fsmoking 1; ^gmyocardial infarction 17; ^hstroke 5; ⁱdiabetes duration 7; ^jretinopathy 12; ^kblindness 8; ^lproteinuria 52; ^mrenal failure 8; ⁿrenal replacement therapy 8; ^oneuropathy 11; ^pamputation 8.

Table 2 Multiple Logistic Regression Models Analyzing the Relationship Between Diagnosed and Undetected Diabetes and the Development of High Depressive Symptoms: The Heinz Nixdorf Recall Study

	N	Incident Cases n (%)	Model 1: OR (95%-CI)	Model 2: OR (95%-CI)	Model 3: OR (95%-CI)	Model 4: OR (95%-CI)
		(% 95%-CI)
Diagnosed diabetes	201	31 (15.4%)	1.51 (1.01–2.28)	1.40 (0.92–2.12)	1.33 (0.87–2.02)	1.46 (0.96–2.21)
		(10.7–21.2%)
Undetected diabetes	158	16 (10.1%)	0.96 (0.56–1.65)	0.85 (0.49–1.47)	0.85 (0.49–1.48)	0.76 (0.43–1.36)
		(5.9–15.9%)
No diabetes (ref)	2454	304 (12.4%)	1.00	1.00	1.00	1.00
		(11.1–13.8%)
Men
Diagnosed diabetes	132	18 (13.6%)	1.67 (0.98–2.86)	1.59 (0.92–2.76)	1.49 (0.85–2.61)	1.69 (0.97–2.93)
		(8.3–20.7%)
Undetected diabetes	115	8 (7.0%)	0.77 (0.37–1.63)	0.70 (0.33–1.50)	0.69 (0.32–1.49)	0.76 (0.35–1.63)
		(3.1–13.2%)
No diabetes (ref)	1242	115 (9.3%)	1.00	1.00	1.00	1.00
		(7.7–11.0%)
Women
Diagnosed diabetes	69	13 (18.8%)	1.34 (0.71–2.51)	1.24 (0.65–2.35)	1.19 (0.63–2.28)	1.26 (0.66–2.40)
		(10.4–30.1%)
Undetected diabetes	43	8 (18.6%)	1.29 (0.59–2.83)	1.14 (0.51–2.53)	1.18 (0.53–2.62)	0.83 (0.34–2.04)
		(8.4–33.4%)
No diabetes (ref)	1212	189 (15.6%)	1.00	1.00	1.00	1.00
		(13.6–17.8%)

Notes: Different models for diagnosed and undetected diabetes on corresponding subpopulations including reference population. Model 1: adjusted for age and sex. Model 2: Model 1 + additional adjustment for BMI, physical activity, smoking, education (only confounders). Model 3: Model 2 + additional adjustment for myocardial infarction and stroke (confounders + MI + stroke). Model 4: Model 2 + additional adjustment for log-CRP and log-adiponectin (confounders + immunological parameters). Missing: maximal 16 (model 2.3) or 56 (model 4) participants excluded because of missing in each model for diagnosed/undetected diabetes.

Abbreviations: OR, odds ratio; CI, confidence interval.