PROSPECTIVE ANALYSIS OF THE EFFECT OF CHRONIC STRESS ON GLYCEMIC VARIABILITY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Main Article Content
Keywords
Type 2 Diabetes Mellitus, Chronic Stress, Glycemic Variability, Perceived Stress Scale, Continuous Glucose Monitoring
Abstract
Background:
Chronic psychological stress is increasingly recognized as a significant factor influencing glycemic control in individuals with Type 2 Diabetes Mellitus (T2DM). Stress may contribute to glycemic variability (GV) through its effects on hormonal regulation and behavioral patterns. This study aimed to prospectively evaluate the relationship between chronic stress and GV in patients with T2DM.
Materials and Methods:
A total of 120 patients diagnosed with T2DM were enrolled in a 6-month prospective observational study. Participants were evaluated for chronic stress using the Perceived Stress Scale (PSS-10) at baseline and at 3-month intervals. Glycemic variability was assessed through continuous glucose monitoring (CGM) parameters, including standard deviation (SD), coefficient of variation (CV), and mean amplitude of glycemic excursions (MAGE). Data were analyzed using Pearson correlation and multivariate regression to identify associations between stress levels and GV indices.
Results:
Patients with high chronic stress (PSS ≥ 20) showed significantly increased GV parameters compared to those with lower stress levels. The mean SD of glucose readings in the high-stress group was 54.8 ± 11.3 mg/dL versus 42.7 ± 9.5 mg/dL in the low-stress group (p < 0.001). Similarly, MAGE was elevated in the high-stress group (102.3 ± 18.7 mg/dL) compared to the low-stress group (85.6 ± 15.2 mg/dL; p = 0.002). A positive correlation (r = 0.62, p < 0.001) was observed between PSS scores and GV metrics. Multivariate regression confirmed chronic stress as an independent predictor of increased GV.
Conclusion:
Chronic stress significantly contributes to increased glycemic variability in patients with T2DM, independent of HbA1c levels and medication adherence. Routine assessment and management of psychological stress may play a crucial role in optimizing glycemic outcomes in diabetic care.
References
2. Luc K, Schramm-Luc A, Guzik TJ, Mikolajczyk TP. Oxidative stress and inflammatory markers in prediabetes and diabetes. J Physiol Pharmacol. 2019 Dec;70(6). doi:10.26402/jpp.2019.6.01. PMID: 32084643.
3. Madhu SV, Siddiqui A, Desai NG, Sharma SB, Bansal AK. Chronic stress, sense of coherence and risk of type 2 diabetes mellitus. Diabetes Metab Syndr. 2019 Jan-Feb;13(1):18–23. doi:10.1016/j.dsx.2018.08.004. PMID: 30641693.
4. Plíhalová A, Westlake K, Polák J. [Obstructive sleep apnoea and type 2 diabetes mellitus]. Vnitr Lek. 2016 Fall;62(11 Suppl 4):S79–84. PMID: 27921430.
5. Fiore V, De Rosa A, Falasca P, Marci M, Guastamacchia E, Licchelli B, et al. Focus on the Correlations between Alzheimer's Disease and Type 2 Diabetes. Endocr Metab Immune Disord Drug Targets. 2019;19(5):571–9. doi:10.2174/1871530319666190311141855. PMID: 30854980.
6. Indelicato L, Dauriz M, Santi L, Bonora F, Negri C, Cacciatori V, et al. Psychological distress, self-efficacy and glycemic control in type 2 diabetes. Nutr Metab Cardiovasc Dis. 2017 Apr;27(4):300–6. doi:10.1016/j.numecd.2017.01.006. PMID: 28274728.
7. Marcovecchio ML, Chiarelli F. The effects of acute and chronic stress on diabetes control. Sci Signal. 2012 Oct 23;5(247):pt10. doi:10.1126/scisignal.2003508. PMID: 23092890.
8. Smith-Palmer J, Brändle M, Trevisan R, Orsini Federici M, Liabat S, Valentine W. Assessment of the association between glycemic variability and diabetes-related complications in type 1 and type 2 diabetes. Diabetes Res Clin Pract. 2014 Sep;105(3):273–84. doi:10.1016/j.diabres.2014.06.007. PMID: 25023992.
9. Torimoto K, Okada Y, Tanaka Y. [Type 2 Diabetes and Vascular Endothelial Dysfunction]. J UOEH. 2018;40(1):65–75. doi:10.7888/juoeh.40.65. PMID: 29553076.
10. Chang CM, Hsieh CJ, Huang JC, Huang IC. Acute and chronic fluctuations in blood glucose levels can increase oxidative stress in type 2 diabetes mellitus. Acta Diabetol. 2012 Dec;49 Suppl 1:S171–7. doi:10.1007/s00592-012-0398-x. PMID: 22547264.
11. Kar P, Plummer MP, Bellomo R, Jenkins AJ, Januszewski AS, Chapman MJ, et al. Liberal Glycemic Control in Critically Ill Patients With Type 2 Diabetes: An Exploratory Study. Crit Care Med. 2016 Sep;44(9):1695–703. doi:10.1097/CCM.0000000000001815. PMID: 27315191.
12. Hilliard ME, Yi-Frazier JP, Hessler D, Butler AM, Anderson BJ, Jaser S. Stress and A1c Among People with Diabetes Across the Lifespan. Curr Diab Rep. 2016 Aug;16(8):67. doi:10.1007/s11892-016-0761-3. PMID: 27287017.
13. Rashed OA, Sabbah HA, Younis MZ, Kisa A, Parkash J. Diabetes education program for people with type 2 diabetes: An international perspective. Eval Program Plann. 2016 Jun;56:64–8. doi:10.1016/j.evalprogplan.2016.02.002. PMID: 27060766.
14. Surwit RS, Schneider MS. Role of stress in the etiology and treatment of diabetes mellitus. Psychosom Med. 1993 Jul-Aug;55(4):380–93. doi:10.1097/00006842-199307000-00005. PMID: 8105502.
15. Ruz M, Carrasco F, Rojas P, Codoceo J, Inostroza J, Basfi-fer K, et al. Zinc as a potential coadjuvant in therapy for type 2 diabetes. Food Nutr Bull. 2013 Jun;34(2):215–21. doi:10.1177/156482651303400210. PMID: 23964394.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Pinank Mer
Assistant Professor, Department of General Medicine, Geetanjali Medical College, Udaipur, Rajasthan, India