AIMS: Type 2 diabetes is linked to psychological distress and a doubled risk of depression. This study aims to characterize individuals with type 2 diabetes experiencing diabetes distress and/or depression in relation to lifestyle and metabolic outcomes. METHODS: A population-based survey in 2020 targeted individuals with type 2 diabetes (aged 18-75 years) in the Central Denmark Region. This cross-sectional study assessed diabetes distress (using Problem-Area-in-Diabetes-scale) and depression (via hospital diagnosis and prescribed medication) as exposures. Logistic regression, adjusting for potential confounders, compared exposed and non-exposed groups on lifestyle habits, metabolic factors and medication usage related to cardio-metabolic risks. RESULTS: Of 18,222 respondents with type 2 diabetes (46% response rate), 11% had depression, 14% had diabetes distress and 4% had both. Compared to those with neither condition, those with depression were more often smokers (OR: 2.0, 95% CI: 1.8
2.3) and sedentary in leisure time (OR: 2.0, 95% CI: 1.8
2.2). Diabetes distress was associated with elevated HbA1c (OR: 1.8, 95% CI: 1.5
2.0) and treatment with insulin (OR: 1.8, 95% CI: 1.6
2.0). Half with diabetes distress displayed stable blood glucose levels. Those with both conditions had a higher risk of sedentary behaviour (OR: 2.7, 95% CI: 2.3
3.2), clinical insomnia (OR: 6.5, 95% CI: 5.5
7.7) and low self-rated health (OR: 7.5, 95% CI: 6.3
9.0) than those with either psychological condition in isolation. CONCLUSIONS: This study emphasizes the importance of recognizing distinct features and risk factors associated with diabetes distress and depression in individuals with type 2 diabetes. Tailored care strategies for comorbid mental health issues are crucial for comprehensive management.