The large population-based cohort study included participants in the Multifactor Primary Prevention Trial study that was initiated in 1970 in Gothenburg, Sweden. The study was designed to monitor the health of men born from 1915 to 1925 in Gothenburg.

The researchers found that men who reported permanent stress had a 45% increased risk for developing diabetes compared with men who reported having no stress or periodic stress, after adjustment for age, socioeconomic status, physical activity, BMI, systolic blood pressure, and use of blood pressure-lowering medication (HR=1.45; 95% CI, 1.20-1.75).2


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Dr Crump, who conducted his study while at Stanford University, said there is evidence from social psychology research that perceived stress in the United States has increased over the past 3 decades. The problem of high levels of stress is indeed common and an increasing risk factor for type 2 diabetes, he said.

“Low stress resilience may contribute to the development of diabetes through unhealthy lifestyle factors, such as physical inactivity and unhealthy diet, as well as other physiologic hormonal factors, such as increased cortisol levels that contribute to insulin resistance,” Dr Crump told Endocrinology Advisor.

The increased synthesis and release of cortisol potentially caused by stress can lead to a cascade of events contributing to lipolysis and body fat redistribution, he noted. In addition, stress may alter immune function and adversely affect interleukin levels.

Addressing the Problem Sooner Rather Than Later

Although these studies evaluated the relationship between stress and type 2 diabetes in early and mid- to late adulthood, stress during childhood may be also pose health risks.

For example, one study published in the Journal of the American College of Cardiology found that psychological distress in childhood, even when conditions improved in adulthood, was associated with higher risk for heart disease and diabetes later in life.3

The study looked at information related to stress and mental health collected at ages 7, 11, 16, 23, 33, and 42. The researchers also collected data for 9 biological indicators at age 45 using information from blood samples and blood pressure measures to create a score indicating risk for heart disease and diabetes (cardiometabolic risk score).

Data showed that individuals with persistent distress throughout their lives had the highest cardiometabolic risk score compared with those who reported low levels of distress throughout childhood and adulthood (P<.0001). The estimated risk for cardiometabolic disease for individuals with persistent distress through mid-adulthood was higher than the risk commonly observed for individuals who are overweight in childhood.3    

Stress is associated with increases in certain hormones, including catecholamines, cortisones, and thyroid hormones, according to Garry Shen, MD, PhD, professor in the section of endocrinology and metabolism at the University of Manitoba in Canada. He said all of these may affect glucose metabolism and increase blood glucose.  

Dr Shen also noted that chronic stress and low stress resistance favor hyperglycemia. He explained that there is a growing body of scientific evidence suggesting additional rationale for paying sufficient attention to the involvement of stress in the prevention and management of patients with diabetes. He added that clinicians should consider psychological interventions earlier rather than later.