Mental well-being in people with and without diabetes: Results from the Health in Germany panel 2025

Background

Diabetes mellitus is associated with an increased risk of mental health problems, but evidence on its association with positive mental health is limited. Maintaining good quality of life is a key treatment goal in the German ‘National Care Guideline for Type 2 Diabetes’, highlighting the relevance of well-being for successful diabetes management. This study examines the association between diabetes status and mental well-being in a nationwide sample of adults in Germany.

Methods

Data is based on the 2025 annual survey from the panel Health in Germany of the Robert Koch Institute (cross-sectional analyses; 28,153 adults ≥18 years). Diabetes was defined as physician-diagnosed diabetes (excluding gestational diabetes only). Well-being was assessed using the World Health Organization-Five Well-Being Index (WHO-5; range 0-25). Age-adjusted means (M) and proportions of poor well-being (<13) are reported. Weighted prevalence ratios (PR) with 95% confidence intervals (CI) for poor well-being were estimated using Poisson regression, adjusted for age (model 1) and additionally for sex, education, smoking, physical activity, and body mass index (model 2).

Results

In 2025, the average mental well-being of people with diabetes was exactly at the cut-off for poor well-being (n = 2,580; M = 13.1, 95% CI 12.8-13.5), unlike that of people without diabetes (n = 25,573; 14.6, 14.5-14.7). People with diabetes had a higher prevalence of poor well-being than those without diabetes (43.9% vs. 33.8%). In age-adjusted model 1, diabetes was associated with a 1.3-fold (PR 1.30, 95% CI 1.20-1.41) higher prevalence of poor well-being, which was attenuated, but remained statistically significant in model 2 (1.19, 1.10-1.30).

Conclusions

Almost half of the people with diabetes reported poor well-being, indicating a need for mental health conditions to be clarified. To track changes over time, continuous population-based monitoring of well-being among people with diabetes is necessary.

Key messages

• The findings highlight the importance of considering subjective well-being as an integral part of needs-based diabetes care.

• Further research is required to elucidate the determinants of well-being in people with diabetes.