Research · May 01, 2014
TAKE-HOME MESSAGE
- The study assessed the association between psychological distress and incidence of type 2 diabetes in high- and low-risk populations. The prospective cohort of 5932 diabetes-free adults were classified by prediabetes status and Framingham Offspring Type 2 Diabetes Risk Score into four groups: normoglycemia with risk score 0 to 9, normoglycemia with risk score 10 to 19, prediabetes with risk score 10 to 19, and prediabetes with risk score greater than 19. For the normoglycemia and prediabetes groups with low risk, psychological distress (assessed by the General Health Questionnaire) did not predict type 2 diabetes, with incidence between 1.6% and 15.6%. For those with prediabetes and high-risk scores, 40.9% of individuals with psychological distress compared with 28.5% without distress developed diabetes during the follow-up (odds ratio 2.07 [95% CI, 1.19–3.62]).
- In patients with prediabetes and at high risk for psychological distress, diabetes progression was accelerated.
ABSTRACT
OBJECTIVE
We examined whether psychological distress predicts incident type 2 diabetes and if the association differs between populations at higher or lower risk of type 2 diabetes.
RESEARCH DESIGN AND METHODS
Prospective cohort of 5,932 diabetes-free adults (4,189 men and 1,743 women, mean age 54.6 years) with three 5-year data cycles (1991-2009), a total of 13,207 person-observations. Participants were classified into four groups according to their prediabetes status and Framingham Offspring Type 2 Diabetes Risk Score: normoglycemia with a risk score of 0-9, normoglycemia with a risk score of 10-19, prediabetes with a risk score of 10-19, and prediabetes with a risk score of >19. Psychological distress was assessed by the General Health Questionnaire. Incident type 2 diabetes was ascertained by 2-h oral glucose tolerance test, doctor diagnosis, or use of antihyperglycemic medication at the 5-year follow-up for each data cycle. Adjustments were made for age, sex, ethnicity, socioeconomic status, antidepressant use, smoking, and physical activity.
RESULTS
Among participants with normoglycemia and among those with prediabetes combined with a low risk score, psychological distress did not predict type 2 diabetes. Diabetes incidence in these groups varied between 1.6 and 15.6%. Among participants with prediabetes and a high risk score, 40.9% of those with psychological distress compared with 28.5% of those without distress developed diabetes during the follow-up. The corresponding adjusted odds ratio for psychological distress was 2.07 (95% CI 1.19-3.62).
CONCLUSIONS
These data suggest that psychological distress is associated with an accelerated progression to manifest diabetes in a subpopulation with advanced prediabetes.
Psychological Distress and Incidence of Type 2 Diabetes in High-Risk and Low-Risk Populations: The Whitehall II Cohort Study
Diabetes Care 2014 May 01;[EPub Ahead of Print], M Virtanen, JE Ferrie, AG Tabak, TN Akbaraly, J Vahtera, A Singh-Manoux, M Kivimäki
Expert Comment
Primary Care
Mind Matters
Two studies that PracticeUpdate is featuring this week show that the mind matters. Virtanen and colleagues found that for those at high risk for diabetes psychological stress doubled the risk of developing the disease, although this was not the case for those at low risk.1
The second paper was an interesting experiment of the effect of emotions on objective heart measures in women. May and colleagues showed a dichotomy between a negative emotion (anger) and a process to let it go (forgiveness).2 Anger was associated with cardiac risk markers including blood pressure elevation and increased ventricular work, while forgiveness was associated with cardioprotective factors such as lower blood pressure, reduced ventricular work, and lower oxygen demand. The authors pointed out that the cardioprotective effects of forgiveness in this study are similar to those seen with beta blockers.
Another dichotomy in medicine is the constant struggle to influence these parameters externally with medications or internally through a process such as forgiveness. The beta blocker is helpful and can be prescribed quickly but can lead to side effects, polypharmacy, higher cost, and, in general, more reliance on “things” to maintain health. In contrast, forgiveness can stimulate self-healing mechanisms from within with little harm, reducing the need to add more “things,” with the potential to significantly improve overall quality of life.
Although forgiveness is a simple choice, it is a very difficult process to go through and is hard to facilitate in a 15 to 20 minute office visit. Working with our behavioral health colleagues is a good first step. Here is a patient handout on forgiveness that may be helpful for patients who may be carrying a lot of anger.
Forgiveness does not mean that what was done is now okay, but rather it means that through forgiving one chooses not to carry the burden around with for the rest of his or her life, which can potentially reduce the risk of heart disease and diabetes.
I think Martin Luther King said it best, “I have decided to stick with love. Hate is too great a burden to bear.”
References