J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 12, Number 12, December 2020, pages 816-823

Association Between Psychological Distress and Stress-Related Symptoms and Increased Risk of Type 2 Diabetes in Male Individuals: An Observational Study

Figure 1. STROBE flow-chart of participants. STROBE: Strengthening the Reporting of Observational Studies in Epidemiology; HbA1c: HbA1c: hemoglobin A1c.

Figure 2. Kaplan Meier plot of new-onset diabetes in participants based on depression status. Sixty-eight participants without depression at baseline were excluded from the analysis.

**Table 1.** Baseline Characteristics of the Study Participants
Variables	All (n = 6,326)	Non-diabetes (n = 6,197)	New-onset diabetes (n = 129)	P value
Mean (standard deviation) or n (%). BMI: body mass index; HDL-C: high-density lipoprotein cholesterol; HbA1c: hemoglobin A1c.
Age, years	47.4 (9.5)	47.3 (9.5)	52.3 (8.4)	< 0.001
BMI, kg/m²	23.44 (3.38)	23.37 (3.31)	26.94 (4.61)	< 0.001
Smoking, n (%)	2,096 (33.1)	2,048 (33.0)	48 (37.2)	0.320
Exercise, n (%)
Exercise habit	922 (26.3)	898 (26.2)	24 (30.4)	0.403
Physical activity	1,490 (42.5)	1,453 (42.4)	37 (47.4)	0.370
Fast walking speed	1,970 (56.1)	1,931 (56.3)	39 (49.4)	0.220
Dietary habits, n (%)
Skipping breakfast	753 (21.5%)	736 (21.5%)	17 (21.5%)	0.992
Late-night dinner	1,381 (39.4%)	1,356 (39.6%)	25 (31.6%)	0.154
Drinking alcohol, n (%)
Everyday	1,684 (34.5%)	1,651 (34.5%)	33 (32.0%)	0.351
Blood pressure, mm Hg
Systolic	126.2 (15.1)	126.0 (15.0)	134.1 (17.5)	< 0.001
Diastolic	79.6 (10.6)	79.5 (10.6)	85.1 (11.1)	< 0.001
Laboratory data
Triglycerides, mg/dL	119.1 (97.8)	118.2 (97.8)	163.7 (89.1)	< 0.001
HDL-C, mg/dL	62.1 (15.9)	62.3 (15.9)	54.6 (12.9)	< 0.001
HbA1c, %	5.54 (0.31)	5.53 (0.30)	6.13 (0.25)	< 0.001
Psychological variables, points
Vigor	2.2 (0.8)	2.2 (0.8)	2.3 (0.9)	0.905
Anger-irritability	2.1 (0.8)	2.1 (0.8)	2.1 (0.8)	0.423
Fatigue	2.1 (0.8)	2.1 (0.8)	2.1 (0.8)	0.477
Anxiety	2.0 (0.7)	2.0 (0.7)	2.0 (0.7)	0.796
Depression	1.6 (0.6)	1.6 (0.6)	1.6 (0.6)	0.830
Somatic symptom, points
Total score	1.6 (0.5)	1.6 (0.5)	1.7 (0.6)	0.121

Table 1. Baseline Characteristics of the Study Participants

Variables

All (n = 6,326)

Non-diabetes (n = 6,197)

New-onset diabetes (n = 129)

P value

Mean (standard deviation) or n (%). BMI: body mass index; HDL-C: high-density lipoprotein cholesterol; HbA1c: hemoglobin A1c.

Age, years

47.4 (9.5)

47.3 (9.5)

52.3 (8.4)

< 0.001

BMI, kg/m²

23.44 (3.38)

23.37 (3.31)

26.94 (4.61)

< 0.001

Smoking, n (%)

2,096 (33.1)

2,048 (33.0)

48 (37.2)

0.320

Exercise, n (%)

Exercise habit

922 (26.3)

898 (26.2)

24 (30.4)

0.403

Physical activity

1,490 (42.5)

1,453 (42.4)

37 (47.4)

0.370

Fast walking speed

1,970 (56.1)

1,931 (56.3)

39 (49.4)

0.220

Dietary habits, n (%)

Skipping breakfast

753 (21.5%)

736 (21.5%)

17 (21.5%)

0.992

Late-night dinner

1,381 (39.4%)

1,356 (39.6%)

25 (31.6%)

0.154

Drinking alcohol, n (%)

Everyday

1,684 (34.5%)

1,651 (34.5%)

33 (32.0%)

0.351

Blood pressure, mm Hg

Systolic

126.2 (15.1)

126.0 (15.0)

134.1 (17.5)

< 0.001

Diastolic

79.6 (10.6)

79.5 (10.6)

85.1 (11.1)

< 0.001

Laboratory data

Triglycerides, mg/dL

119.1 (97.8)

118.2 (97.8)

163.7 (89.1)

< 0.001

HDL-C, mg/dL

62.1 (15.9)

62.3 (15.9)

54.6 (12.9)

< 0.001

HbA1c, %

5.54 (0.31)

5.53 (0.30)

6.13 (0.25)

< 0.001

Psychological variables, points

Vigor

2.2 (0.8)

2.3 (0.9)

0.905

Anger-irritability

2.1 (0.8)

0.423

Fatigue

2.1 (0.8)

0.477

Anxiety

2.0 (0.7)

0.796

Depression

1.6 (0.6)

0.830

Somatic symptom, points

Total score

1.6 (0.5)

1.7 (0.6)

0.121

**Table 2.** Adjusted Hazard Ratio for Developing Type 2 Diabetes
Variables	Prevalence, %	Adjusted hazard ratio^a	P value
^aAdjusted for age, body mass index, and hemoglobin A1c. *P value < 0.05.
Psychological variables
Vigor	47.7	0.88 (0.62 - 1.25)	0.478
Anger-irritability	39.8	1.29 (0.91 - 1.83)	0.156
Fatigue	45.6	1.06 (0.74 - 1.51)	0.753
Anxiety	47.7	0.89 (0.62 - 1.26)	0.506
Depression	31.4	1.54 (1.07 - 2.22)	0.020*
Stress-related symptom
1. Dizziness	4.8	1.07 (0.47 - 2.45)	0.864
2. Joints pain	11.7	1.20 (0.72 - 2.00)	0.490
3. Headache	10.6	1.98 (1.18 - 3.34)	0.010*
4. Shoulder stiffness	33.2	1.56 (1.10 - 2.23)	0.014*
5. Lumbago	28.8	1.10 (0.75 - 1.61)	0.626
6. Tired eyes	38.6	1.24 (0.87 - 1.77)	0.234
7. Short of breath	5.1	1.37 (0.71 - 2.63)	0.345
8. Bowel problems	11.9	1.28 (0.72 - 2.29)	0.398
9. Appetite loss	4.3	1.43 (0.62 - 3.33)	0.403
10. Constipation/diarrhea	14.3	1.71 (1.04 - 2.80)	0.034*
11. Insomnia	15.5	1.07 (0.67 - 1.70)	0.784

Table 2. Adjusted Hazard Ratio for Developing Type 2 Diabetes

Variables

Prevalence, %

Adjusted hazard ratio^a

P value

^aAdjusted for age, body mass index, and hemoglobin A1c. *P value < 0.05.

Psychological variables

Vigor

47.7

0.88 (0.62 - 1.25)

0.478

Anger-irritability

39.8

1.29 (0.91 - 1.83)

0.156

Fatigue

45.6

1.06 (0.74 - 1.51)

0.753

Anxiety

47.7

0.89 (0.62 - 1.26)

0.506

Depression

31.4

1.54 (1.07 - 2.22)

0.020*

Stress-related symptom

1. Dizziness

4.8

1.07 (0.47 - 2.45)

0.864

2. Joints pain

11.7

1.20 (0.72 - 2.00)

0.490

3. Headache

10.6

1.98 (1.18 - 3.34)

0.010*

4. Shoulder stiffness

33.2

1.56 (1.10 - 2.23)

0.014*

5. Lumbago

28.8

1.10 (0.75 - 1.61)

0.626

6. Tired eyes

38.6

1.24 (0.87 - 1.77)

0.234

7. Short of breath

5.1

1.37 (0.71 - 2.63)

0.345

8. Bowel problems

11.9

1.28 (0.72 - 2.29)

0.398

9. Appetite loss

4.3

1.43 (0.62 - 3.33)

0.403

10. Constipation/diarrhea

14.3

1.71 (1.04 - 2.80)

0.034*

11. Insomnia

15.5

1.07 (0.67 - 1.70)

0.784

**Table 3.** Adjusted Hazard Ratio for Developing Type 2 Diabetes According to the Depression Subscale
Variables	Prevalence, %	Adjusted hazard ratio^a	P value
^aAdjusted for age, body mass index, and hemoglobin A1c. *P value < 0.05.
Depression subscale
1. I have been depressed	19.8	1.18 (0.77 - 1.82)	0.441
2. I have thought that doing anything was a hassle	12.8	1.21 (0.71 - 2.09)	0.482
3. I have been unable to concentrate	11.2	1.34 (0.75 - 2.39)	0.323
4. I have felt gloomy	20.5	1.30 (0.83 - 2.02)	0.252
5. I have been unable to handle work	5.4	2.18 (1.14 - 4.19)	0.019*
6. I have felt sad	8.5	1.93 (1.14 - 3.26)	0.015*

Table 3. Adjusted Hazard Ratio for Developing Type 2 Diabetes According to the Depression Subscale

Variables

Prevalence, %

Adjusted hazard ratio^a

P value

^aAdjusted for age, body mass index, and hemoglobin A1c. *P value < 0.05.

Depression subscale

1. I have been depressed

19.8

1.18 (0.77 - 1.82)

0.441

2. I have thought that doing anything was a hassle

12.8

1.21 (0.71 - 2.09)

0.482

3. I have been unable to concentrate

11.2

1.34 (0.75 - 2.39)

0.323

4. I have felt gloomy

20.5

1.30 (0.83 - 2.02)

0.252

5. I have been unable to handle work

5.4

2.18 (1.14 - 4.19)

0.019*

6. I have felt sad

8.5

1.93 (1.14 - 3.26)

0.015*

**Table 4.** Correlation of Psychological Variables With Dietary Habits and Alcohol Consumption
Variables	Vigor	Anger-irritability	Fatigue	Anxiety	Depression
Dietary habits
Skipping breakfast	-0.001	0.065	0.059	0.055	0.076
P value	0.930	< 0.001	< 0.001	< 0.001	< 0.001
Late-night dinner	-0.026	0.118	0.165	0.122	0.126
P value	0.133	< 0.001	< 0.001	< 0.001	< 0.001
Drinking alcohol
Everyday	0.001	0.019	-0.024	0.011	-0.005
P value	0.929	0.197	0.097	0.461	0.710

Table 4. Correlation of Psychological Variables With Dietary Habits and Alcohol Consumption

Variables

Vigor

Anger-irritability

Fatigue

Anxiety

Depression

Dietary habits

Skipping breakfast

-0.001

0.065

0.059

0.055

0.076

P value

0.930

< 0.001

Late-night dinner

-0.026

0.118

0.165

0.122

0.126

P value

0.133

< 0.001

Drinking alcohol

Everyday

0.001

0.019

-0.024

0.011

-0.005

P value

0.929

0.197

0.097

0.461

0.710