Does vital exhaustion increase the risk of type 2 diabetes? A prospective study
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.
Section snippets
Study population
Baseline data were obtained from the Copenhagen City Heart Study (CCHS), which is a large prospective study, comprising a random sample of Danish women and men aged 20 and older living in the Copenhagen area. At the first examination in 1976–1978, 14,233 participants (response rate 74%) were examined and filled in a self-administered questionnaire. Four following examinations were conducted in 1981–1983 (CCHS2), 1991–1993 (CCHS3), 2001–2003 (CCHS4) and 2012–2015 (CCHS5) examining the original
Characteristics of the study population
Table 1 presents characteristics of women and men separately comprising each group of VE score.
A total of 73.4% of the participants reported a VE score of one or more. The scores ranged across the scale from 0 to 17 points with women generally reporting a higher degree of VE than men with the average VE score among women being 4.2 compared with 3.0 for men (data not shown). Congruently, a high degree of VE (VE score of 6 or more) was reported by 28.8% of the women and 17.8% of men (Table 1).
Discussion
This article presents two substudies based on self-reported and register-based measures of type 2 diabetes respectively. Both found an association between a high degree of VE at baseline and an increased risk of developing type 2 diabetes. In the first substudy, the group with a VE score of 6.5 or higher had an OR of 2.56 (P < 0.001) of developing type 2 diabetes, and in the second substudy the group with a VE score of 6 or more had an OR of 1.31 (P = 0.053) of developing type 2 diabetes.
Competing interest statement
The authors have no competing interests to report.
Acknowledgements
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. We sincerely thank the Copenhagen City Heart Study and all of the participants for the data.
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