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. 2024 May 15:12:1289689.
doi: 10.3389/fpubh.2024.1289689. eCollection 2024.

Cross-sectional associations of self-perceived stress and hair cortisol with metabolic outcomes and microvascular complications in type 2 diabetes

Magdalena Buckert  1 , Carmen Streibel  1 , Mechthild Hartmann  1 , Nelly Monzer  1 , Stefan Kopf  2 , Julia Szendrödi  2   3 , Beate Wild  1
Affiliations

Cross-sectional associations of self-perceived stress and hair cortisol with metabolic outcomes and microvascular complications in type 2 diabetes

Magdalena Buckert et al. Front Public Health. .

Abstract

Introduction: Increasing evidence supports chronic psychological stress as a risk factor for the development of type 2 diabetes. Much less is known, however, about the role of chronic stress in established diabetes.

Methods: The aim of the current study was to comprehensively assess chronic stress in a sample of 73 patients with type 2 diabetes and 48 non-diabetic control participants, and to investigate associations with indicators of glycemic control (HbA1c), insulin resistance (HOMA-IR), β-cell functioning (C-peptide), illness duration, and the presence of microvascular complications. Chronic stress was measured using questionnaires [the Perceived Stress Scale (PSS), the Screening Scale of the Trier Inventory of Chronic Stress (SSCS), the Perceived Health Questionnaire (PHQ) as well as the Questionnaire on Stress in Patients with Diabetes-Revised (QSD-R)]; hair cortisol was used as a biological indicator.

Results: We found that patients with type 2 diabetes had higher levels of hair cortisol in comparison to the control group (F(1,112) = 5.3; p = 0.023). Within the diabetic group, higher hair cortisol was associated with a longer duration of the illness (r = 0.25, p = 0.04). General perceived stress did not show significant associations with metabolic outcomes in type 2 diabetes patients. In contrast, higher diabetes-related distress, as measured with the QSD-R, was associated with lower glycemic control (r = 0.28, p = 0.02), higher insulin resistance (r = 0.26, p = 0.03) and a longer duration of the illness (r = 0.30, p = 0.01).

Discussion: Our results corroborate the importance of chronic psychological stress in type 2 diabetes. It appears, however, that once type 2 diabetes has developed, diabetes-specific distress gains in importance over general subjective stress. On a biological level, increased cortisol production could be linked to the course of the illness.

Keywords: HbA1c; hair cortisol; microvascular complications; psychological stress; type 2 diabetes.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Hair cortisol concentration (mean ± SEM) in patients with type 2 diabetes with and without complications and in the non-diabetic control group (* p < 0.05).
See this image and copyright information in PMC

References

    1. Dennick K, Sturt J, Speight J. What is diabetes distress and how can we measure it? A narrative review and conceptual model. J Diabetes Complicat. (2017) 31:898–911. doi: 10.1016/j.jdiacomp.2016.12.018, PMID: - DOI - PubMed
    1. Asuzu CC, Walker RJ, Williams JS, Egede LE. Pathways for the relationship between diabetes distress, depression, fatalism and glycemic control in adults with type 2 diabetes. J Diabetes Complicat. (2017) 31:169–74. doi: 10.1016/j.jdiacomp.2016.09.013, PMID: - DOI - PMC - PubMed
    1. Braizat O, Feinn R, Abbott G, Wagner J. Relationship style and glycaemic control in women with type 2 diabetes: the mediating role of psychological distress. Stress Health. (2018) 34:462–7. doi: 10.1002/smi.2795, PMID: - DOI - PubMed
    1. Fisher L, Mullan JT, Arean P, Glasgow RE, Hessler D, Masharani U. Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care. (2010) 33:23–8. doi: 10.2337/dc09-1238, PMID: - DOI - PMC - PubMed
    1. Ismail K, Moulton CD, Winkley K, Pickup JC, Thomas SM, Sherwood RA, et al. . The association of depressive symptoms and diabetes distress with glycaemic control and diabetes complications over 2 years in newly diagnosed type 2 diabetes: a prospective cohort study. Diabetologia. (2017) 60:2092–102. doi: 10.1007/s00125-017-4367-3, PMID: - DOI - PMC - PubMed

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