Effect of psychological stress on glucose control in patients with Type 2 diabetes.
Level 3 - non-randomized controlled study
Non-randomized controlled experimental study
PubMed 21883440 · doi:10.1111/j.1464-5491.2011.03431.x
What was done
Thirty patients with Type 2 diabetes (12 female, mean age 60 ± 12 years, BMI 28.8 ± 4.2 kg/m², diabetes duration 8.9 ± 6.7 years, HbA1c 51 ± 9 mmol/mol) were subjected to acute psychological stress using the Trier Social Stress Test in a non-randomized study. Ten patients underwent testing in the fasting state and 20 patients underwent testing 75 minutes after a standard meal. Blood pressure, heart rate, salivary cortisol, and continuous glucose monitoring were compared between a control day and the stress-test day.
What was found
On the stress-test day, blood pressure increased from 117/73 ± 13/12 to 155/92 ± 22/14 mmHg, heart rate increased from 77 ± 11 to 91 ± 25 beats/min, and salivary cortisol rose from 8.5 ± 3.7 to 26.4 ± 12.1 nmol/l (all P < 0.001), while remaining stable on the control day. In the postprandial group, stress resulted in significantly higher glucose concentrations compared to the control day (mean difference 1.5 mmol/l, 95% CI 0.5–2.4, P = 0.003). In the fasting group, glucose concentrations showed no significant difference between stress and control days (mean difference 0.7 mmol/l, 95% CI -0.7 to 2.0, P = 0.31).
Why it matters
This study provides experimental evidence that acute psychological stress impairs glycemic control in patients with Type 2 diabetes specifically during the postprandial window rather than the fasting state.
Limits
The sample size was small (n = 30 total; n = 10 in the fasting group), the allocation was non-randomized, and an acute laboratory stressor was used which may not fully reflect real-world or chronic psychological stress.
Cited by
- supports Psychological stress increases blood glucose levels.