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

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

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.

MeSH terms

  • Adult
  • Aged
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / metabolism
  • Diabetes Mellitus, Type 2* / psychology
  • Female
  • Glycated Hemoglobin / analysis
  • Glycated Hemoglobin / metabolism
  • Hair* / chemistry
  • Hair* / metabolism
  • Humans
  • Hydrocortisone* / analysis
  • Hydrocortisone* / metabolism
  • Insulin Resistance
  • Male
  • Middle Aged
  • Risk Factors
  • Stress, Psychological* / metabolism
  • Surveys and Questionnaires

Substances

  • Hydrocortisone
  • Glycated Hemoglobin

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The study was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)–project numbers WI 4115/5-1 and 236360313 (SFB 1118). The funding sources had no role in the design of the study; the collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication.