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Diabetes and Vascular Disease

SUN-613 - Association of Insulin Therapy with Increased Suicide Risk in Adults with Diabetes: A Nationwide Population-Based Cohort Study

Sunday, June 14, 2026
9:00 AM - 4:00 PM CT
Location: ENDOExpo; Poster Floor
Disclosure(s):
Ho Jin Cha, MD: No financial relationships to disclose
Background
Individuals with diabetes mellitus have been shown in several previous studies to experience greater psychological burden than the general population. However, the relationship between insulin therapy and suicide risk among individuals with type 1 diabetes (T1D) and type 2 diabetes (T2D) remains under-investigated, particularly in T2D. This study aimed to examine the association between insulin therapy and suicide risk among adults with T1D, non-insulin-treated T2D, and insulin-treated T2D using a nationwide population-based cohort.

Methods
This retrospective population-based cohort study used the National Health Insurance Service (NHIS) database in Korea. Adults aged ≥20 years who underwent national health screening were categorized as non–insulin-treated T2D, insulin-treated T2D, T1D, and non-diabetes. The composite suicide outcome was defined as the occurrence of either death by suicide or suicide attempt requiring hospitalization. Suicidal attempts were identified based on inpatient admissions for intentional self-harm or related mechanisms of injury. Associations between diabetes groups and suicide risk were examined using multivariable Cox proportional hazards models, with adjustment for demographics, socioeconomic status, lifestyle factors, and clinical comorbidities including antidepressant use. Sensitivity analyses were also performed to assess consistency of this study.

Results
In this study, analyses were conducted using data from 1,828,019 individuals. The median age was 48 years, and the median follow-up duration was 9.05 years. Composite suicide risk was significantly higher in insulin-treated T2D (adjusted hazard ratio [aHR] = 1.41, 95% confidence interval [CI] = 1.19–1.67) and T1D (aHR = 1.75, 95% CI = 1.37–2.25), but not in non–insulin-treated T2D (aHR = 1.02, 95% CI = 0.97–1.08), compared with the non-diabetes population. Similar patterns were observed for suicide attempts. Suicide mortality was significantly increased in T1D (aHR = 1.77, 95% CI = 1.11–2.82), whereas insulin-treated T2D showed an elevated but non-statistically significant risk (aHR = 1.14, 95% CI = 0.79-1.64). No significant differences were observed based on insulin type, and findings remained consistent across all sensitivity and subgroup analyses.

Conclusion
Adults with T1D and insulin-treated T2D exhibited a significantly higher risk of suicide in this nationwide cohort. This elevated risk in insulin-treated groups may be attributed to the cumulative psychological burden of frequent glucose monitoring and daily self-injections, further exacerbated by disease progression and fear of hypoglycemia. These findings highlight the increased vulnerability to psychological distress among these populations, underscoring the critical need for routine mental health screening as an essential component of diabetes care.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*