Does vital exhaustion increase the risk of type 2 diabetes? A prospective study

Highlights

• The average Vital Exhaustion score was 4.2 for women and 3.0 for men.

• Vital exhaustion score showed a significant association with type 2 diabetes.

• The OR of developing diabetes was 2.56 among the quartile with the highest score.

Abstract

Background

There is evidence that both stress and depression have a causal relationship with type 2 diabetes suggesting that vital exhaustion (VE) too could be a risk factor. The association between VE and type 2 diabetes has, however, not been investigated prospectively.

Aim

To prospectively investigate whether VE is associated with an increased risk of type 2 diabetes in a Danish population.

Methods

A prospective cohort study based on the Copenhagen City Heart Study (1991–1993). The degree of VE was measured among 9075 participants without type 1 or 2 diabetes at baseline. To detect type 2 diabetes in the follow-up period, two different approaches were used: In the first substudy, type 2 diabetes was defined based on blood samples and questionnaires from a follow-up study in 2001–2003 (N = 4708). The second substudy was register-based, and the study population was linked to the Danish Hospital Discharge Register to detect registrations with type 2 diabetes until 2014.

Results

A high degree of VE was associated with an increased risk of developing type 2 diabetes in both substudies.

In the first substudy, the OR for developing type 2 diabetes was 2.56 (95% CI, 1.53; 4,29, P < 0,001) among the quartile of participants reporting the highest degree of VE.

In the second substudy, the OR was 1.31 (95% CI, 0.99; 1.72, P = 0.053) for this group.

Conclusion

The results indicate that VE may be a useful measure in clinical practice in order to discover individuals at risk of type 2 diabetes.

Introduction

Type 2 diabetes is a major public health issue and poses a big economic challenge worldwide [1]. As diabetes is considered a global epidemic, it is of great relevance and importance to uncover risk factors that effectively identifies empirically supported preventive interventions.

The term Vital Exhaustion (VE) describes a state of physical and mental exhaustion characterized by excessive fatigue, feelings of demoralization and increased irritability [2]. Overwork or the inability to solve a long-standing problem was identified as possible instigators for VE [3]. VE is widely studied in relation to cardiovascular diseases, e.g. proving to be predictive of stroke [4], isolated angina pectoris, myocardial infarctions and fatal coronary heart disease [3] and has previously been associated with a higher risk of all-cause mortality [5]. Furthermore, Schnor et al. have recently suggested that VE is one of the most important risk factors for coronary heart disease [6]. Thus, VE has been shown to predict heart disease and stroke, which are both common causes of death in people with diabetes [7]. Furthermore, there is convincing evidence that heart disease and diabetes share several psychological risk factors such as socioeconomic position, stress, and depression [8], [9], [10], [11], [12], suggesting that VE, in addition to being predictive of heart disease and mortality, may be a risk factor for diabetes.

This is the first study to prospectively investigate the association between VE and the risk of type 2 diabetes. Some studies have indicated a correlation between the two: A cross sectional study found an association between a high VE score and self-reported diabetes [5] and a study of mediating psychosocial factors of the close relationship between socio-economic status and metabolic syndrome, found a significant graded association between VE and the risk of a high metabolic syndrome score [13]. As the metabolic syndrome is a group of risk factors associated with development of type 2 diabetes [14], this study also supports the hypothesis of an association between VE and type 2 diabetes. Congruently, a study exploring several psychological risk factors in men found VE to be most consistently linked to metabolic changes leading to type 2 diabetes [15]. Thus, there are some indications that a high degree of VE would elevate the risk of developing type 2 diabetes. However, no studies have specifically investigated this association, and the aim of the current study is to prospectively investigate the association of VE and later risk of type 2 diabetes in a large Danish population.