Tuesday , December 12 2017
Home / Conditions / Type 2 Diabetes / Stress Could Be Contributor to Progression of Type 2 Diabetes

Stress Could Be Contributor to Progression of Type 2 Diabetes

Type 2 diabetes patients were more likely to have lower stress reactivity and impaired stress recovery when compared to healthy subjects…

Stress-related factors are thought to play a role in the development of type 2 diabetes. Such factors have an impact on metabolic, cardiovascular and inflammatory regulation. Previous studies have been performed to determine how individuals respond to allostatic load (“wear and tear on the body” when exposed to chronic stress), a measure of stress. Biomarkers such as blood pressure, cortisol levels, glycated hemoglobin and inflammatory markers are often used to measure allostatic load. Previous results have shown conflicting results when assessing allostatic load in type 2 diabetes patients.

The purpose of this study was to test whether type 2 diabetes patients would be more likely to have a high dynamic allostatic load. The researchers hypothesized that those with type 2 diabetes would show blunted stress reactivity and impaired recovery from stress. The researchers used blood pressure, heart rate, cortisol levels, serum cholesterol and interleukin-6 as biomarkers to measure allostatic load. Biomarkers were recorded following mental stress testing. Questionnaires were also used to measure the physiological stress-related factors. A total of 140 type 2 diabetes patients were matched by age, sex and income to 280 subjects without a diabetes diagnosis.

Results showed that stress reactivity was blunted in the diabetes group when compared to the control group using systolic blood pressure for measurement (OR 0.97, 95% CI 0.95-0.99, P=0.007). Recovery from stress was reduced at both time intervals measured, 40-45 minutes post-stress and 70-75 minutes post-stress (OR 0.98, 95% CI 0.96-0.99, P=0.028) and (OR 0.97, 95% CI 0.95-0.99, P=0.004). Cortisol levels were found to be higher in the diabetes group (P<0.001). Following stress-related tasks, interleukin-6 increase was blunted at both 45 minutes (P=0.021) and 75 minutes (P=0.028) in the diabetes group. The increase in serum cholesterol was blunted in the diabetes group (OR 0.02, 95% CI 0.001-0.27, P= 0.004). The recovery was also reduced in this group (OR 0.018, 95% CI 0.001-0.88, P= 0.043). Finally, subjects in the diabetes group were more likely to report a stressful experience and negative emotions like depressive symptoms based on the results of the questionnaires.

The results of this cross-sectional study showed a lower stress reactivity and an impaired post-stress recovery in subjects with diabetes when compare to nondiabetes subjects. This was seen in the results of blood pressure, serum cholesterol, cortisol and inflammatory biomarkers. Multiple biological systems appear to be impacted by mental stress in type 2 diabetes patients. Due to the design of this study, a causal relationship cannot be determined based on these results alone.

Practice Pearls:

  • Stress-related factors are believed to play a potential role in the progression of type 2 diabetes
  • Results showed type 2 diabetes patients were more likely to have lower stress reactivity and impaired stress recovery when compared to healthy subjects
  • Biomarkers showed the impact of stress on type 2 diabetes patients across multiple biological systems

Steptoe A, Hackett RA, Lazzarino AI, Bostock S, LaMarca R et al. Disruption of multisystem responses to stress in type 2 diabetes: Investigating the dynamics of allostatic load. 2014 http://www.pnas.org/content/early/2014/10/15/1410401111.short