Stress May Increase Risk for Type 2 Diabetes

Study Questions:

Is psychosocial stress associated with risk for type 2 diabetes?

Methods:

Data from a national cohort study of military conscripts in Sweden during 1969-1997 (97-98% of all 18-year-old men nationwide each year) were used for the present study. All men ages 18 years were required to complete a medical examination, except males who were incarcerated or had severe medical conditions. Those who had a prior diagnosis of diabetes were also excluded. These participants also underwent a standardized psychological assessment for stress resilience (on a scale of 1-9). The primary outcome of interest was type 2 diabetes identified from outpatient and inpatient diagnoses during 1987-2012 (maximum attained age, 62 years).

Results:

A total of 1,534,425 men were included in the study, of which 34,008 (2.2%) men were diagnosed with type 2 diabetes over 39.4 million person-years of follow-up. The median age at the end of follow-up was 46.1 years (mean 45.9 years, standard deviation [SD] 8.9, range 19.0-62.0 years). The median age at diagnosis of type 2 diabetes was 46.8 years (mean 44.7 years, SD 9.9, range 18.0-62.0 years). Low stress resilience was associated with an increased risk of developing type 2 diabetes after adjusting for body mass index (BMI), family history of diabetes, and individual and neighborhood socioeconomic factors (hazard ratio for lowest vs. highest quintile, 1.51; 95% confidence interval, 1.46-1.57; p < 0.0001). This association did not vary by BMI level, family history of diabetes, or socioeconomic factors.

Conclusions:

The investigators concluded that low stress resilience may play an important long-term role in etiological pathways for type 2 diabetes. Further elucidation of the underlying causal factors may help inform more effective preventive interventions across the lifespan.

Perspective:

These data suggest that the importance of psychologic well-being is related to chronic conditions such as diabetes. Whether interventions to reduce stress would result in lower risk for diabetes is an important next question.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Stress

Keywords: Body Mass Index, Diabetes Mellitus, Type 2, Glycosylation End Products, Advanced, Metabolic Syndrome X, Military Personnel, Primary Prevention, Risk, Socioeconomic Factors, Stress, Psychological


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