Linking glucose swings and mental health to cardiovascular outcomes and mortality in general practice

The global rise in type 2 diabetes mellitus (T2DM) underscores the importance of early prevention in primary care. This study examined how changes in glucose tolerance and the presence of neuropsychiatric disorders relate to cardiovascular outcomes (CVO) and mortality. In a 10-year longitudinal study, 1,069 general practice patients (mean age 62.9 years; 51% male) underwent standard 2-hour glucose tolerance tests (GTT). Data on lifestyle, cardiovascular risk factors, comorbidities, and neuropsychiatric diagnoses (MINI Interview) were collected. The difference between baseline and follow-up GTT values (GTTdiff) was analyzed in relation to cardiovascular events and mortality. Patients who died had significantly higher GTTdiff (mean 1.37 mmol/L) compared to those with CVO (0.95 mmol/L) or without events (0.81 mmol/L; p = .002). Kaplan-Meier analysis showed shorter survival in patients with Major Depressive Episode (MDE) and GTTdiff > 3 mmol/L (7.43 years) versus those without MDE (8.76 years). Greater glucose variability and comorbid depression are associated with increased cardiovascular mortality. Interventions targeting both glucose control and mental health may improve outcomes in non-diabetic primary care populations.