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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• 作者：Else-Marie Dalsgaard (1)
  Mogens Vestergaard (1) (2)
  Mette V. Skriver (3)
  Helle T. Maindal (3)
  Torsten Lauritzen (1)
  Knut Borch-Johnsen (4)
  Daniel Witte (5)
  Annelli Sandbaek (1)
  
• 关键词：All ; cause mortality ; Cardiovascular risk factors ; Complications ; General practice ; Mental health ; Morbidity ; Type 2 diabetes mellitus
• 刊名：Diabetologia
• 出版年：2014
• 出版时间：April 2014
• 年：2014
• 卷：57
• 期：4
• 页码：710-717
• 全文大小：202 KB
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• 作者单位：Else-Marie Dalsgaard (1)
  Mogens Vestergaard (1) (2)
  Mette V. Skriver (3)
  Helle T. Maindal (3)
  Torsten Lauritzen (1)
  Knut Borch-Johnsen (4)
  Daniel Witte (5)
  Annelli Sandbaek (1)
  
  1. Department of Public Health, Section for General Practice, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark
  2. Research Unit for General Practice, Aarhus University, Aarhus, Denmark
  3. Section for Health Promotion and Health Services, Department of Public Health, Aarhus University, Aarhus, Denmark
  4. Holbaek Hospital, Holbaek, Region Zealand, Denmark
  5. Centre de Recherche Public de la Santé, Strassen, Luxembourg
  
• ISSN：1432-0428

文摘

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 40-9?years with screen-detected type 2 diabetes mellitus identified in general practice during 2001-006 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 ?8 (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.