Background: There is evidence that both stress and depression have a causal relationship with type 2 diabetes suggesting that vital exhaustion (VE) too could be a risk factor. The association between VE and type 2 diabeteshas, however, not been investigated prospectively.

Aim: To prospectively investigate whether VE is associated with an increased risk of type 2 diabetes in a Danish population.

Methods: A prospective cohort study based on the Copenhagen City Heart Study (1991–1993). The degree of VE was measured among 9075 participants without type 1 or 2 diabetes at baseline. To detect type 2 diabetes in the follow-up period, two different approaches were used: In the first substudy, type 2 diabetes was defined based onblood samples and questionnaires from a follow-up study in 2001–2003 (N = 4708). The second substudy was register-based, and the study population was linked to the Danish Hospital Discharge Register to detect registrations with type 2 diabetes until 2014.

Results: A high degree of VE was associated with an increased risk of developing type 2 diabetes in both substudies. In the first substudy, the OR for developing type 2 diabetes was 2.56 (95% CI, 1.53; 4,29, P < 0,001) among the quartile of participants reporting the highest degree of VE. In the second substudy, the OR was 1.31 (95% CI, 0.99; 1.72, P = 0.053) for this group.

Conclusion: The results indicate that VE may be a useful measure in clinical practice in order to discover individuals at risk of type 2 diabetes.