The Association of Burnout and Vital Exhaustion With Type 2 Diabetes: A Systematic Review and Meta-Analysis

M. Strikwerda, J.W. Beulens, S. Remmelzwaal, L.J. Schoonmade, A. van Straten, M.T. Schram, P.J. Elders, F. Rutters*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

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Objective This study aimed to investigate the association of burnout and vital exhaustion with measures of glycemic control and type 2 diabetes (T2D) in a systematic review and meta-analysis. Methods PubMed, Embase, and PsycINFO were searched from inception to April 2, 2020. Data extraction and quality assessment were performed using the Effective Public Health Practice Project tool. When possible, results were meta-analyzed using random-effects models and rated using the Grading of Recommendations, Assessment, Development and Evaluation. Results A total of 5317 titles/abstracts were screened, 140 articles were read full text, of which 29 studies were included. Eighteen studies were cross-sectional, three prospective and eight were case-control studies. Burnout and vital exhaustion were significantly associated with T2D, with a pooled odds ratio of 1.8 (95% confidence interval [CI] = 1.4 to 2.4, I-2 = 79%; 9 studies). Glycated hemoglobin A(1c) levels were not significantly higher in people with burnout and vital exhaustion, compared to those without, with a pooled standardized mean difference of 0.35 (95% CI = -0.62 to 1.33, I-2 = 98%; 7 studies). In addition, no differences in glucose levels were observed (standardized mean difference = 0.02, 95% CI = -0.26 to 0.30, I-2 = 90%; 9 studies). Sensitivity analyses showed no decrease in heterogeneity when excluding studies with low quality (I-glucose(2) = 89%) or studies with a study n < 40 population (I-T2D(2) = 77%). The level of Grading of Recommendations, Assessment, Development and Evaluation evidence was moderate to low quality because of 18 studies having a cross-sectional design. Conclusions Burnout and vital exhaustion might be associated with a higher risk of T2D, but not with glycemic control. Methodological shortcomings and high heterogeneity of the studies included complicate the interpretation of our results.
Original languageEnglish
Pages (from-to)1013-1030
Number of pages18
JournalPsychosomatic Medicine
Issue number9
Publication statusPublished - 1 Nov 2021


  • burnout
  • vital exhaustion
  • glycemic control
  • type 2 diabetes
  • systematic review
  • meta-analysis
  • glycated hemoglobin A(1c)
  • glucose
  • CI = confidence interval
  • GRADE = Grading of Recommendations
  • Assessment
  • Development and Evaluation
  • HbA(1c) = glycated hemoglobin A(1c)
  • HOMA-IR = homeostatic model assessment insulin resistance
  • OR = odds ratio
  • T2D=type 2 diabetes


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