Obesity Mediates the Effect of Past and Current Mental Health on Diabetes Treatment Outcomes

Background: anxiety and depression (a&d) are common among patients with diabetes (dm). we assessed the mediatory effect of obesity on the pathway between past and current mental health (as measured by a&d) on self-care dm treatment adherence and dm treatment failure.methods: we used data collected in two rounds (2009-12, 2014-2018) of a population-based cohort study in kerman, iran (kercadrs). by a random cluster sampling approach, 5900 residents of kerman aged 15 to 75 yr were recruited to the study to measure demographic characteristics, body measures (to calculate bmi), ad-herence to dm treatment, and symptoms for a&d (beck questionnaires). fasting blood also collected for bio-chemical tests and glycemic control (as an indicator for treatment failure). we used path analysis and structural equation modeling (sem) for analysis.results: we analyzed data for 264 patients with diabetes who attended in both study rounds. while only 5.7% reported not adherence to dm treatment, 67.9% had diabetes treatment failure. past mental health had a signif-icant positive association with hba1c (standard beta coefficient for total effect =0.148, p=0.044), of which 42% was indirect effect through obesity. current mental health had a positive association with current no ad-herence to diabetes treatment (standard beta coefficient for total effect=0.077, p=0.001).conclusion: our study showed an important indirect path from a&d to diabetes treatment failure outcome which mediated by obesity. screening for a&d symptoms and treating those as well as obesity among patients with diabetes may improve glycemic control.