ORIGINAL ARTICLE Factors associated with anxiety in type 2 diabetes mellitus patients in Pakistan Muhammad Sarfraz Nawaz 1 & Kifayat Ullah Shah 1 & Haroon Ur Rashid 1 & Sajid Mahmood 1 & Allah Bukhsh 2,3 & Inayat Ur Rehman 2 & Salamat Ali 1 & Tahir Mehmood Khan 2 Received: 10 July 2017 /Accepted: 30 October 2017 # Research Society for Study of Diabetes in India 2017 Abstract The aim of this study was to assess the factors as- sociated with anxiety in type 2 diabetes mellitus patients (T2DM) by using Hamilton Anxiety Rating Scale (HAM- A). A cross-sectional quantitative study was conducted after necessary ethical approval from Medicare Hospital Rawalpindi and Capital Development Authority Hospital Islamabad in accordance with Declaration of Helsinki. Three hundred thirty-eight patients with type 2 diabetes mellitus were selected by non-stratified random sampling technique from August 2016 to February 2017. Majority of the T2DM patients (n = 258, 66.5%) had mild anxiety, followed by mild to moderate anxiety (n = 82, 21.1%). A significant association (p < 0.01) was observed between anxiety and patients’ gender, education, and occupation; whereas, statistically insignificant association (p > 0.05) was observed between HAM-A score and patients’ age, family history, and life style. Linear regres- sion analysis revealed gender (OR = - 0.308, CI-0.57-0.299) as a significant predictor (p < 0.01) for anxiety. Findings of this study demonstrate that large proportion of the diabetic patients is suffering with type of anxiety. A significant asso- ciation of anxiety was identified with gender, education, and occupation of type 2 diabetes patients. Keywords Blood sugar fasting . Blood sugar random . Diabetes mellitus . Anxiety . HAM-A . Pakistan . Type 2 diabetes mellitus Introduction In the current era, diabetes mellitus has become a major health care problem [1]. Diabetes mellitus is a metabolic multi- factorial disorder induced by either decrease in insulin produc- tion or increased insulin resistance in the body. The prevalence of type 2 diabetes is increasing rapidly. International Diabetic Federation (IDF) reports showed that around 415 million peo- ple have been diagnosed with diabetes mellitus and presum- ably this number would reach 642 million by 2040; there are seven million cases of diabetes in Pakistan till 2015 [2]. According to WHO diabetes prevalence list, Pakistan is on top seventh position. Diabetes doubles the risk of heart disease by increasing oxidative stress in patients. More than 8% of the US myocardial infarction cases are due to diabetes [3]. Total expenditure on diagnosed diabetes is 245 billion dollars in USA by 2012 [4]; while in Pakistan, average cost per patient per month is 5542 Pak rupees [5]. Anxiety and depression are associated with both duration as well as disease of diabetes mellitus. Anxiety disorder is about 21% more prevalent in diabetic patients than non-diabetic popu- lation [6, 7]. Anxiety and depression are more commonly ob- served in female than male patients. There are many factors such as unemployment, low income and poor glycemic control etc., which are associated with patient ’ s anxious behavior [8, 9]. There is a limited data available on association of diabetes with anxiety in developing country. Mexican diabetic patients show more anxiety level than others [10]. Gois et al. reported the asso ciation of anxiety with glycemic control, a good diabetes control makes diabetic patient comfortable and poor glycemic control * Kifayat Ullah Shah kushah@qau.edu.pk 1 Department of Pharmacy, Quaid-i-Azam University Islamabad, Islamabad, Pakistan 2 School of Pharmacy, Monash University, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia 3 Institute of Pharmaceutical Sciences, University of Veterinary and Animal Science, Lahore, Pakistan Int J Diabetes Dev Ctries https://doi.org/10.1007/s13410-017-0591-0