Prevalence of Depression and Anxiety in Patients with Type 2 Diabetes Mellitus and Their Association with Glycemic Control: A Cross-Sectional Study

Background: Depression and anxiety are common yet underrecognized comorbidities in patients with type 2 diabetes mellitus (T2DM). Both conditions may adversely influence self-management and contribute to poor glycemic outcomes, but local data from South Asia remain limited. Objective: To determine the prevalence of depression and anxiety in adults with T2DM and examine their association with glycemic control. Methods: A cross-sectional study was conducted among 90 adults with T2DM attending two tertiary care hospitals in Punjab, Pakistan. Depression and anxiety were assessed using validated Urdu/English versions of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7). Glycemic control was indexed by glycated hemoglobin (HbA1c), measured with NGSP-certified assays. Logistic and linear regression models evaluated associations between psychological morbidity and HbA1c, adjusting for demographic and clinical covariates. Results: The mean age of participants was 54.8 ± 10.2 years; 47.8% were male. Mean diabetes duration was 9 years (IQR 5–13). Moderate-to-severe depressive symptoms were present in 31.1% and clinically significant anxiety in 27.8%; 17.8% had both conditions. Diabetes distress was reported by 36.7%. Participants with depression had significantly higher HbA1c than those without (8.5 ± 1.3% vs. 7.6 ± 1.3%; p<0.001). Anxiety was similarly associated (8.4 ± 1.2% vs. 7.6 ± 1.4%; p=0.003). In adjusted models, depression remained independently linked to higher HbA1c (β=+0.32%, p=0.002), and screen-positive depression doubled the odds of poor glycemic control (OR=2.41, 95% CI 1.03–5.61). Conclusion: Depression and anxiety are prevalent among Pakistani adults with T2DM and strongly correlate with poor glycemic control. Integrating routine mental health screening and multidisciplinary interventions into diabetes care could improve both psychological well-being and metabolic outcomes.