INTEGRATED PHYSIOLOGICAL, BIOCHEMICAL AND PSYCHIATRIC PREDICTORS OF GLYCEMIC CONTROL AND CARDIOMETABOLIC RISK IN ADULTS WITH TYPE 2 DIABETES MELLITUS: AN OBSERVATIONAL STUDY

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a complex multisystem disorder driven by metabolic dysfunction, chronic systemic inflammation, and psychiatric co-morbidities. While physiological metrics and metabolic biomarkers are routinely monitored in clinical practice, the combined predictive contribution of biological markers and psychiatric factors (such as depression, anxiety, and diabetes-related distress) toward glycemic control and overall cardiometabolic risk remains insufficiently quantified in integrated observational models. Objective: To evaluate the integrated predictive value of baseline physiological parameters, systemic biochemical markers, and psychiatric symptom scores for suboptimal glycemic control (HbA1c ≥ 8.0%) and elevated 10-year cardiometabolic risk in adults with type 2 diabetes mellitus. Methods: This prospective observational study evaluated 160 adult patients (aged 30 to 70 years) with established type 2 diabetes mellitus attending outpatient clinics at M.Islam Medical College. Physiological evaluations included resting blood pressure, body mass index (BMI), waist circumference, and pulse wave velocity (PWV). Biochemical assays quantified glycated hemoglobin (HbA1c), lipid profiles (total cholesterol, triglycerides, LDL-C, HDL-C), high sensitivity C-reactive protein (hs-CRP), fasting plasma glucose, and estimated glomerular filtration rate (eGFR). Psychiatric profiles were evaluated using validated psychometric instruments: Patient Health Questionnaire-9 (PHQ 9 for depression), Generalized Anxiety Disorder-7 (GAD-7 for anxiety), and Diabetes Distress Scale-17 (DDS-17 for disease-specific distress). Cardiometabolic risk was estimated using the 10-year UKPDS Risk Engine. Bivariate correlations and multivariable logistic regression analyses were conducted to establish independent predictors. Results: Among 160 adults (mean age 52.4 +/- 9.8 years; 53.8 percent female), suboptimal glycemic control (HbA1c ≥ 8.0%) was present in 46.3 percent (n = 74). Clinically significant depressive symptoms (PHQ-9 score ≥ 10) were identified in 33.8 percent (n = 54), generalized anxiety (GAD-7 score ≥ 10) in 26.3 percent (n = 42), and high diabetes distress (DDS-17 score ≥ 3.0) in 38.8 percent (n = 62). Patients with suboptimal glycemic control exhibited significantly higher hs-CRP (4.8 +/−1.8 vs. 2.2 +/−0.9 mg/L, p < 0.001), elevated systolic blood pressure (142.6 +/−16.2 vs. 128.4 +/−12.4 mmHg, p < 0.001), higher DDS-17 scores (3.4 +/−0.8 vs. 2.1 +/−0.6, p < 0.001), and elevated PHQ-9 scores (11.8 +/−4.2 vs. 6.4 +/−2.8, p < 0.001). Multivariable logistic regression revealed that high diabetes distress (adjusted OR = 3.84, 95 percent CI: 1.78 to 8.28, p = 0.001), elevated hs-CRP > 3.0 mg/L (adjusted OR = 3.12, 95 percent CI: 1.48 to 6.58, p = 0.003), moderate-to-severe depression (PHQ-9 ≥ 10; adjusted OR = 2.76, 95 percent CI: 1.24 to 6.14, p = 0.013), and abdominal obesity (waist circumference; adjusted OR = 2.18, 95 percent CI: 1.04 to 4.56, p = 0.038) independently predicted suboptimal glycemic control. Combined physiological, biochemical, and psychiatric profiling achieved an area under the ROC curve (AUC) of 0.864 for predicting high 10-year cardiovascular risk. Conclusion: Suboptimal glycemic control and elevated cardiometabolic risk in T2DM are strongly governed by an interplay between systemic bio-inflammatory pathways and psychological burden. High diabetes distress, elevated systemic inflammation (hs-CRP), and depressive symptoms are independent predictors of adverse metabolic trajectories. Incorporating routine psychiatric screening alongside standard physiological and biochemical testing is essential for comprehensive diabetes care and cardiovascular risk reduction.