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Psychological distress, cardiovascular complications and mortality among people with screen-detected type 2 diabetes: follow-up of the ADDITION-Denmark trial

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Abstract

Aims/hypothesis

The aim of this study was to examine the association between psychological distress and the risk of cardiovascular disease (CVD) events and all-cause mortality in patients with screen-detected type 2 diabetes mellitus. In addition, we explored whether or not metabolic control and medication adherence could explain part of this association.

Methods

A follow-up study was performed including 1,533 patients aged 40–69 years with screen-detected type 2 diabetes mellitus identified in general practice during 2001–2006 in the Denmark arm of the ADDITION (Anglo–Danish–Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care) study. Mental health was measured at baseline with the Mental Health Inventory 5 (MHI-5). Psychological distress was defined as an MHI-5 score of ≤68 (18.2% of the population). CVD risk factors were measured at baseline and repeated at the follow-up examination. Information on death, hospital discharge diagnosis, and antihypertensive and lipid-lowering drug treatment was obtained from national registers. Cox proportional regression was used to estimate HRs for the association between psychological distress, CVD events and all-cause mortality. Age- and sex-adjusted risk difference analyses were performed to estimate differences in meeting treatment targets.

Results

Patients with psychological distress had a 1.8-fold higher mortality rate (HR 1.76, 95% CI 1.23, 2.53) and a 1.7-fold higher risk of having a CVD event (HR: 1.69, 95% CI 1.05, 2.70) compared with those with an MHI-5 score of >68. Overall, psychological distress was not associated with the ability to meet treatment targets for HbA1c levels, cholesterol levels or BP, or to redeem antihypertensive or lipid-lowering drug treatment.

Conclusions/interpretation

In people detected and treated early in the diabetes disease trajectory, those with psychological distress at the time of diagnosis had a higher risk of CVD events and death than those without psychological distress.

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Abbreviations

ACCORD:

Action to Control Cardiovascular Risk in Diabetes

ADDITION:

Anglo–Danish–Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care

CVD:

Cardiovascular disease

GHQ-12:

General Health Questionnaire 12

MET:

Metabolic equivalent value

MHI-5:

Mental Health Inventory 5

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Funding

ADDITION-Denmark was supported by the National Health Services in the counties of Copenhagen, Aarhus, Ringkøbing, Ribe and South Jutland in Denmark, The Danish Council for Strategic Research, the Danish Research Foundation for General Practice, Novo Nordisk Foundation, the Danish Centre for Evaluation and Health Technology Assessment, the Danish Fund of the National Board of Health, the Danish Medical Research Council, and the Aarhus University Research Foundation. The trial has been given unrestricted grants from Novo Nordisk AS, Novo Nordisk Scandinavia AB, Novo Nordisk UK, ASTRA Denmark, Pfizer Denmark, Glaxo SmithKline Pharma Denmark, Servier Denmark A/S and HemoCue Denmark A/S. Parts of the grants from Novo Nordisk Foundation and Novo Nordisk were transferred to the other centres.

Duality of interest

KBJ holds shares in Novo Nordisk A/S and has been an invited speaker with honorarium paid by Eli Lilly, Novo Nordisk, Takeda and Sanofi-Aventis within the past 5 years. TL holds shares in Novo Nordisk A/S and has given five lectures for the medical industry within the past 2 years. DW holds shares in Novo Nordisk A/S. MV is supported by an unrestricted grant from the Lundbeck Foundation. All other authors declare that there is no duality of interest associated with their contribution to this manuscript.

Contribution statement

EMD, AS, MV, MVS, TL, DW, HTM and KBJ contributed to the design of the study and participated in the interpretation of data; EMD drafted the paper and all authors revised it critically. The final version was approved by all authors.

Author information

Authors and Affiliations

  1. Department of Public Health, Section for General Practice, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark

    Else-Marie Dalsgaard, Mogens Vestergaard, Torsten Lauritzen & Annelli Sandbaek

  2. Research Unit for General Practice, Aarhus University, Aarhus, Denmark

    Mogens Vestergaard

  3. Section for Health Promotion and Health Services, Department of Public Health, Aarhus University, Aarhus, Denmark

    Mette V. Skriver & Helle T. Maindal

  4. Holbaek Hospital, Holbaek, Region Zealand, Denmark

    Knut Borch-Johnsen

  5. Centre de Recherche Public de la Santé, Strassen, Luxembourg

    Daniel Witte

Authors
  1. Else-Marie Dalsgaard
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  2. Mogens Vestergaard
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  3. Mette V. Skriver
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  4. Helle T. Maindal
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  5. Torsten Lauritzen
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  6. Knut Borch-Johnsen
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  7. Daniel Witte
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  8. Annelli Sandbaek
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Corresponding author

Correspondence to Else-Marie Dalsgaard.

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Dalsgaard, EM., Vestergaard, M., Skriver, M.V. et al. Psychological distress, cardiovascular complications and mortality among people with screen-detected type 2 diabetes: follow-up of the ADDITION-Denmark trial. Diabetologia 57, 710–717 (2014). https://doi.org/10.1007/s00125-014-3165-4

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