Journal
DIABETES CARE
Volume 35, Issue 5, Pages 1067-1073Publisher
AMER DIABETES ASSOC
DOI: 10.2337/dc11-1288
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Funding
- Diabetes UK [09/0003833]
- National Health and Medical Research Council (NHMRC) [586623, 233200]
- Lions Foundation
- Victorian Government
- Australian Government Department of Health and Ageing, City Health Centre-Diabetes Service-Canberra
- Department of Health and Community Services-Northern Territory
- Department of Health and Human Services-Tasmania
- Department of Health-New South Wales
- Department of Health-Western Australia
- Department of Health South Australia
- Department of Human Services-Victoria
- Diabetes Australia
- Diabetes Australia Northern Territory
- Estate of the Late Edward Wilson
- Jack Brockhoff Foundation
- Kidney Health Australia
- Marian FH Flack Trust
- Menzies Research Institute
- Pratt Foundation
- Abbott Australasia Pty Ltd
- Alphapharm Pty Ltd
- AstraZeneca
- Bristol-Myers Squibb
- Eli Lilly Australia
- GlaxoSmithKline
- Janssen-Cilag
- Merck Sharp Dohme
- Novartis Pharmaceuticals
- Novo Nordisk Pharmaceuticals
- Pfizer Pty Ltd
- Queensland Health
- Roche Diagnostics Australia
- Royal Prince Alfred Hospital (Sydney, New South Wales, Australia)
- sanofi-aventis
- Sanofi-Synthelabo
- Diabetes UK [09/0003833] Funding Source: researchfish
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OBJECTIVE-There is an established link between health-related functioning (HRF) and cardiovascular disease (CVD) mortality, and it is known that those with diabetes predominantly die of CVD. However, few studies have determined the combined impact of diabetes and impaired HRF on CVD mortality. We investigated whether this combination carries a higher CVD risk than either component alone. RESEARCH DESIGN AND METHODS-The Australian Diabetes, Obesity and Lifestyle (AusDiab) study included 111,247 adults aged >= 2.5 years from 42 randomly selected areas of Australia. At baseline (1999-2000), diabetes status was defined using the World Health Organization criteria and HRF was assessed using the SF-36 questionnaire. RESULTS Overall, after 7.4 years of follow-up, 57 persons with diabetes and 105 without diabetes had died from CVD. In individuals with and without diabetes, HRF measures were significant predictors of increased CVD mortality. The CVD mortality risks among those with diabetes or impaired physical health component summary (PCS) alone were similar (diabetes only: hazard ratio 1.4 [95% CI 0.7-2.7]; impaired PCS alone: 1.5 [1.0-2.4]), while those with both diabetes and impaired PCS had a much higher CVD mortality (2.8 [1.6-4.7]) compared with those without diabetes and normal PCS (after adjustment for multiple covariates). Similar results were found for the mental health component summary. CONCLUSIONS This study demonstrates that the combination of diabetes and impaired HRF is associated with substantially higher CVD mortality. This suggests that, among those with diabetes, impaired HRF is likely to be important in the identification of individuals at increased risk of CVD mortality.
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