Can Low Resistance to Stress Raise Type 2 Diabetes Risk?

Stress and how it affects daily life may significantly influence a person’s risk for developing type 2 diabetes later in life, according to a study recently published in Diabetologia.

For the study, researchers examined a cohort of all 1 534 425 military conscripts in Sweden during 1969–1997 — a time period during which national service was compulsory in Sweden. The cohort included 97% to 98% of all men aged 18 years nationwide each year.

Only men who had no previous diagnosis of diabetes were included in the study.

All men underwent standardized psychological assessment for stress resilience on a scale of 1 to 9. They were followed from 1987 through 2012 for development of type 2 diabetes, as identified from outpatient and inpatient diagnoses. Maximum attained age was 62 years.

“Most studies of stress in relation to diabetes have examined stressful life experiences in mid-adulthood. To our knowledge this is the first study to examine stress resilience earlier in life in relation to the long-term risk of diabetes in adulthood,” said study author Casey Crump, MD, PhD, vice chair for research in the department of family medicine and community health at the Icahn School of Medicine at Mount Sinai in New York.

“The most surprising finding was that stress resilience at such a young age is fairly strongly linked with higher risk of diabetes over a lengthy follow-up period (average follow-up lasting longer than 25 years), even after adjusting for other common risk factors,” added Dr Crump.

Resistance to Stress and Type 2 Diabetes Risk

In the study, 34 008 men were diagnosed with type 2 diabetes during 39.4 million person-years of follow-up. Low stress resilience was associated with an increased risk for developing type 2 diabetes after adjusting for body mass index (BMI), family history of diabetes, and individual and neighborhood socioeconomic factors.¹

Additionally, the study demonstrated that the 20% of men with the lowest resistance to stress (scores 1 to 3) were significantly more likely to have been diagnosed with diabetes than the 20% with the highest resistance to stress (scores 7 to 9; hazard ratio [HR]=1.51; 95% CI, 1.46-1.57).¹

The researchers also found that the diabetes risk decreased in a linear fashion with increased resistance to stress, and there was a linear trend in risk across the full range of stress resilience (P for trend <.0001).¹

“This study suggests that stress resilience may play an important long-term role in the development of diabetes across the life course.  The findings can help inform diabetes prevention programs by better addressing psychosocial risk factors and stress management across the lifespan,” Dr Crump told Endocrinology Advisor.

The study also indicated that high BMI was the strongest risk factor for type 2 diabetes, with results showing that risk for the disease was increased by more than 6-fold for those who were obese at baseline and more than 3-fold for those who were overweight at baseline.

Family history also appeared to be a factor. Data indicated that type 2 diabetes risk was more than twice as high for those with a first-degree family history of diabetes.

Possible Mechanisms

Results from another study conducted in Sweden demonstrated a similar association between stress and risk for type 2 diabetes. This study showed that men who reported permanent stress had a significantly higher risk for developing the disease than men who reported no stress.²