Symptoms and Diabetes among Chinese Middle-Aged and Elderly Adults with Prediabetes: A National Cohort Study

We aimed to assess the association between depressive symptoms and the risk of transition from prediabetes to diabetes. We included 3,956 adults with prediabetes aged 45 years and above in 2011. Participants with a ten-item Center for Epidemiologic Studies Depression (CES-D) score of 10 or higher were classified as having depressive symptoms. Incident diabetes was defined as a self-reported physician diagnosis of diabetes, or treatment with glucose-lowering medication in 2013, 2015, or 2018. Among 3, 956 participants (mean age was 59.53 years old and 53.29% were female), the proportion of depressive symptoms was 36.50% in 2011. During the 24,831 person-years of follow-up, 458 participants developed diabetes and the incidence rate was 18.44 (95% CI 16.83 to 20.21) per 1000 person-years. Depressive symptoms were significantly associated with a higher risk of incident diabetes (HR, 1.31; 95% CI, 1.07 to 1.59). In addition, the association was in a dose-response fashion (P trend < 0.001). Compared with the CES-D <10 group, the HRs (95% CI) were 1.21 (0.98 to 1.49) in the 10≤ CES-D <21 group, and 1.95 (1.38 to 2.75) in the CES-D ≥ 21 group. Depressive symptoms were shown as an independent risk factor for the progression from prediabetes to diabetes.