title: Effect of psychological stress on glucose control in patients with Type 2 diabetes.
abstract: OBJECTIVE
  To investigate the effect of acute psychological stress on glucose concentrations in patients with Type 2 diabetes, in the fasting state as well as in the postprandial state.
  
  
  METHODS
  Thirty patients (12 female) with Type 2 diabetes were included. Mean ± SD age was 60 ± 12 years, BMI 28.8 ± 4.2 kg/m(2), diabetes duration 8.9 ± 6.7 years and HbA(1c) 51 ± 9 mmol/mol (6.8 ± 0.8%). Using a non-randomized approach, all participants were exposed to moderate psychological stress by means of the Trier Social Stress Test: 10 participants in the fasting state and 20 participants 75 min after intake of a standard meal. Blood pressure, heart rate and salivary cortisol were monitored on the control day and the stress-test day. Glucose concentrations were assessed using a continuous glucose monitoring system.
  
  
  RESULTS
  On the stress-test day, blood pressure rose from 117/73 ± 13/12 to 155/92 ± 22/14 mmHg, heart rate from 77 ± 11 to 91 ± 25 b min(-1) and salivary cortisol concentrations from 8.5 ± 3.7 to 26.4 ± 12.1 nmol/l (P < 0.001); these measurements remained unchanged on the control day. On the stress-test day, when the Trier Social Stress Test was applied 75 min after the intake of a standard meal, the glucose concentrations were significantly higher compared with the control day (mean difference 1.5 mmol/l, 95% CI 0.5-2.4, P = 0.003). In the fasting state, glucose concentrations slightly decreased during the control day but remained stable on the stress-test day (mean difference compared with the control day 0.7 mmol/l, 95% CI -0.7 to 2.0, P = 0.31).
  
  
  CONCLUSIONS
  When stress is experienced in the postprandial period, acute psychological stress significantly increases glucose concentrations in patients with Type 2 diabetes.
authors: Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital, Zurich, Switzerland.
authors: M
authors: M
authors: Faulenbach
authors: H
authors: H
authors: Uthoff
authors: K
authors: K
authors: Schwegler
authors: G A
authors: GA
authors: Spinas
authors: C
authors: C
authors: Schmid
authors: P
authors: P
authors: Wiesli
mesh_terms: D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D018660:Blood Pressure Monitoring, Ambulatory; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000378:metabolism* / Q000503:physiopathology / Q000523:psychology; D005215:Fasting / Q000378:metabolism*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D011581:Psychological Tests; D012463:Saliva / Q000378:metabolism; D013315:Stress, Psychological / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006854:Hydrocortisone