EASD: Having Diabetes and Feeling Bad Add Up to Shorter Life

Laura Venskutonyte, MD, a fellow in medicine at Karolinska Institutet, Stockholm, Sweden stated that, after 1,000 days in the study, women and men who scored above the median on the quality-of-life scale had similar survival rates -- about 88% to 90%, but men with scores below the median had about a 77% survival (P=0.031).

"A low rating score was a significant predictor of cardiovascular events, cardiovascular mortality, and all-cause-mortality in men with type 2 diabetes mellitus and acute myocardial infarction," said Venskutonyte in her presentation at the annual meeting of the European Association for the Study of Diabetes.

Venskutonyte noted that, "I think that when we have patients who don't feel well, we should work harder to change their risk factors." She said she anticipated future studies in which the rating scale would be used to determine which patients required more intense intervention.

She reported outcomes from a substudy of the DIGAMI 2 (Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction 2) trial. Researchers enrolled 1,235 patients from 28 centers in seven European countries, and randomized them into three treatment groups. The patients were followed for a median of 2.1 years.

The object of the study was to determine which of three strategies was best for patients with type 2 diabetes and a history of heart disease. The researchers saw no difference in the strategies.

Embedded in the larger DIGAMI study was a 509-patient substudy in which individuals were questioned regarding their quality of life at the time of hospital admission for the MI. Their self-reported quality of life was calculated on the basis of a 100-point graded rating scale in which feelings of near death were rated as 0 and excellent health was graded as 100.

The researchers looked for an association between quality of life and all-cause mortality, cardiovascular death, and cardiovascular events. Venskutonyte said that the analysis included 465 people who completed the questionnaires at baseline and at 12 months -- 316 men and 149 women. The women were older than the men -- 71 years of age versus 65 years of age (P<0.001).

During the follow-up period, 152 patients experienced a cardiovascular event, and 86 people died, including 70 from cardiovascular events, she said. The rating scale scores at admission were significantly lower in patients who experienced a cardiovascular event. Patients who experienced an event had a score of about 62, while those who did not have an event had average scores of 69 (P<0.001). The scores were similar for those who died from cardiovascular events (P=0.012) and from all-cause mortality (P<0.01).

• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• Explain that a substudy of a larger trial found that men with type 2 diabetes who had low quality-of-life scores on admission for an acute MI had an increased risk of subsequent cardiovascular events and mortality.
• Note that quality of life scores were determined by self-report, and that the same findings did not apply in women.

Kjellstrom B, et al "Health-related quality of life predicts survival in patients with type 2 diabetes and myocardial infarction: a report from the DIGAMI2 trial" EASD 2011; Abstract 6.