Letter to the editor in response to “The relationship between depressive symptoms and glycemic control is stronger in women with type 2 diabetes in South Asians: Results from a cross‐sectional multicenter study”

Dear Editor,

We read with great interest the article “The relationship between depressive symptoms and glycemic control is stronger in women with type 2 diabetes in South Asians: Results from a cross‐sectional multicenter study (1)”. This study addresses a vital intersection of endocrinology and mental health in the context of South Asian populations. The findings regarding sex differences in the relationship between depressive symptoms and glycemic control are timely and significant. However, we respectfully highlight the following points, which we believe require further consideration to enhance the clarity and impact of the study.

1. Causation cannot be inferred from cross‐sectional data.

   As this is a cross‐sectional study, the findings establish an association but not causation between depressive symptoms and glycemic control. It remains unclear whether depression leads to poor glycemic control, vice versa, or whether both influence each other. A longitudinal study design would allow a better understanding of the temporal and potentially bidirectional nature of this relationship.

2. The absence of psychosocial data could result in residual confounding.

   Although the study successfully accounts for clinical variables (e.g., HbA1c, duration of diabetes), it does not account for important psychosocial characteristics such as social support networks, employment, income level, and marital status. In LMICs, where gender roles and access to care frequently differ significantly, these factors are particularly pertinent to understanding sex‐based inequities. Ignoring them could result in residual confounding and possibly overstate the influence of sex interactions.

3. Lack of information on comorbidities or consequences associated with diabetes.

   Depressive symptoms may be caused independently by the severity of comorbid chronic illnesses (e.g., hypertension, cardiovascular disease) or diabetes‐related consequences (e.g., neuropathy, retinopathy). It is challenging to determine the precise role that glycemic management plays in depression levels because such clinical characteristics were not taken into account or compensated for in the regression models.

In conclusion, this study makes a significant contribution by highlighting sex‐specific disparities in depression among individuals with type 2 diabetes in South Asia. Addressing limitations such as study design, unmeasured psychosocial factors, and clinical comorbidities in future research will strengthen the validity and applicability of these findings.

DISCLOSURE

The authors declare no conflicts of interest.

Approval of the research protocol: No ethics approval was required for this study.

Informed consent: N/A.

Approval date of Registry and the Registration No. of the study/trial: N/A.

Animal Studies: N/A.

FUNDING

The authors declare that no funds, grants, or other support was received during the preparation of this manuscript.

DATA AVAILABILITY STATEMENT

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.