Established risk factors for type 2 diabetes in adults with depression: implications for endocrine practice

Background Type 2 diabetes mellitus (T2DM) shares multiple modifiable and non-modifiable risk factors across populations, yet it is unclear whether these risk profiles differ in adults with depression—a group with elevated baseline metabolic risk. Objective To identify clinical, behavioral, and sociodemographic predictors of incident T2DM among adults with depression and determine their implications for endocrine prevention and screening strategies. Methods We conducted a retrospective cohort analysis of 40,585 adults with a documented depression diagnosis but no prior T2DM in the All of Us Research Program (median follow-up = 8.15 years). Incident T2DM was defined using electronic health record–based diagnosis codes. Cox proportional hazards models estimated adjusted hazard ratios (HRs) for T2DM as a function of gender, race, ethnicity, age, body mass index (BMI per 10 kg/m²), and household income. Sensitivity analyses incorporated cigarette smoking and multiple imputation for BMI. Results Higher BMI (HR = 1.76 per 10 kg/m²; 95% CI: 1.69–1.83), older age (HR = 1.03 per year; 95% CI: 1.027–1.032), male gender (HR = 1.38; 95% CI: 1.27–1.49), Black race (HR = 1.79; 95% CI: 1.64–1.95), and non-Hispanic ethnicity (HR = 1.37; 95% CI: 1.10–1.71) were independently associated with greater T2DM risk, while higher household income was protective (HR = 0.47 for >$150k vs. <$35k; 95% CI: 0.39–0.58), demonstrating a clear socioeconomic gradient. Associations were robust to smoking adjustment and multiple imputation, and were directionally consistent with patterns reported in prior general-population studies. Conclusions Traditional demographic, socioeconomic, and clinical risk factors were associated with incident T2DM among adults with depression, supporting attention to established diabetes risk factors in psychiatric and endocrine prevention settings. Aggressive implementation of weight management, risk stratification, and early screening—particularly among socioeconomically disadvantaged patients—may reduce the burden of T2DM in psychiatric populations. Clinical trial number Not applicable.