The relationship between depressive symptoms and glycemic control is stronger in women with type 2 diabetes in South Asians: Results from a cross‐sectional multicenter study

Introduction While the bidirectional relationship between depression and diabetes is well recognized, the outcome of studies evaluating the potential for sex disparity, especially in low‐to‐middle‐income (LMIC) South Asian countries, is unexplored. We evaluated sex differences in the relationship between depressive symptoms and glycemic control in individuals with type 2 diabetes in Bangladesh. Methods 1,485 unselected individuals with, and 228 without, type 2 diabetes completed the PHQ‐9 (depression screening questionnaire), and sociodemographic and clinical data were obtained. The PHQ‐9 scores were categorized as mild (5–10), moderate (10–15), moderately severe (15–20), and severe (≥20) depressive symptoms, with scores ≥10 indicating clinically relevant symptoms. Descriptive statistics and ordinal and binary logistic regression analyses were performed. Results In individuals with type 2 diabetes, mean HbA1c was 9.8 ± 0.1%, with no difference between sexes (9.9 ± 0.1% vs 9.7 ± 0.2%, P = 0.39). The overall mean PHQ‐9 score was 8.5 ± 0.2, with females exhibiting higher scores (9.5 ± 0.2 vs 7.1 ± 0.2, P < 0.001). Depressive symptoms correlated with older age, lower education level, longer diabetes duration (>5 years: OR: 1.5, 95% CI: 1.1–2.3), suboptimal (HbA1c 7–9%: OR: 1.8, 95% CI: 1.1–3.2), and poorer glycemic control (HbA1c ≥9%: OR, 1.7; 95% CI, 1.1–2.9). Suboptimal (OR: 2.2, 95% CI: 1.1–4.3) or poor (OR: 2.5, 95% CI: 1.3–4.9) glycemic control and diabetes duration of 1–5 years (OR: 1.9, 95% CI: 1.2–3.0) and >5 years (OR: 2.4, 95% CI: 1.5–3.9) were associated with an increased likelihood of mild‐to‐severe depressive symptoms in females, but not in males. Conclusion The association of depressive symptoms and poor glycemic control in type 2 diabetes in South Asians is stronger in females.