Depressive symptoms in adults with type 2 diabetes clustered into six distinct phenotypes, with sleep-dominant (37%) and fatigue-dominant (17%) profiles prevalent even when probable MDD was uncommon.
Cross-Sectional (n=2,640)
Yes
Depressive symptoms in adults with type 2 diabetes cluster into six distinct phenotypes, highlighting the importance of a symptom-phenotype-based approach over MDD-only screening.
Introduction and Objective: Depression is a heterogeneous construct characterized by diverse cognitive-affective and somatic symptoms and is linked to worse diabetes outcomes. We identified depressive symptom profiles among adults with type 2 diabetes (T2D) and examined their association with demographic characteristics, comorbidity burden, A1c, and probable major depressive disorder (MDD) as defined by the PHQ-9 DSM-based symptom algorithm. Methods: NHANES 2007-2018 provided data on adults with T2D who completed the PHQ-9. Latent profile analysis was conducted for item responses among participants with complete PHQ-9 data. Evaluated parameters included age, body mass index (BMI), hypertension, kidney disease, retinopathy, and atherosclerotic cardiovascular disease (ASCVD). Results: In this sample (N = 2,640, 51.7% female; age = 61.7±11.9 (M±SD) years; A1c = 7.2±1.0%; BMI = 33.5±7.7), mean PHQ-9 score was 5.5±4.8. Weighted prevalence was 73.2% for hypertension, 9.7% for kidney disease, 18.4% for retinopathy/eye complications, and 30.0% for ASCVD. Six profiles were identified with good separation (entropy = 0.88): sleep dominant (n = 970, 37%); severe affective (n = 73, 3%); fatigue dominant (n = 460, 17%); mixed mood-somatic (n = 610, 23%); moderate mixed (n = 122, 5%); minimal fatigue-only (n = 405, 15%). Demographic characteristics and comorbidity burden were similar across profiles. Above target glycemic control (A1c ≥ 7%) ranged from 41.1% (fatigue-dominant) to 55.2% (severe affective) across profiles. Probable MDD prevalence was 7.3% and was concentrated in the severe affective and moderate mixed profiles. Conclusion: Depressive symptoms clustered into six distinct phenotypes among adults with T2D in a national dataset, with sleep and fatigue complaints prevalent even when probable MDD was less common. These findings support moving beyond MDD-only screening toward a symptom-phenotype-based approach, prioritizing integrated diabetes care pathways that address functional burden alongside depression evaluation and referral. Disclosure A. Shapira: None. A. Adam: None. L.M. Laffel: Other - Travel support for scientific presentations; Ended; Boehringer Ingelheim International GmbH. Other - DSMB Chair; Ended; Janssen Pharmaceuticals, Inc. Consultant; Current; Dexcom, Inc. Advisory Panel; Current; Medtronic, Sequel, Tandem Diabetes Care, Inc. Consultant; Current; Roche Diabetes Care, Sinocare. Advisory Panel; Ended; Sanofi. Advisory Panel; Current; MannKind Corporation. J.S. Gonzalez: None. Funding K23 DK134877
Shapira et al. (Fri,) conducted a cross-sectional in Type 2 diabetes (n=2,640). Depressive symptom profiles was evaluated on Identification of depressive symptom profiles and their association with demographics, comorbidities, A1c, and probable MDD. Depressive symptoms in adults with type 2 diabetes clustered into six distinct phenotypes, with sleep-dominant (37%) and fatigue-dominant (17%) profiles prevalent even when probable MDD was uncommon.