title: Sex-related differences in the association of salivary cortisol levels and type 2 diabetes. Findings from the cross-sectional population based KORA-age study.
abstract: Dysregulation in the cortisol secretion may have a role in the development of type 2 diabetes although conflicting evidence on the particular cortisol secretion patterns and type 2 diabetes demands further investigations. We aim to examine the association of cortisol levels and diurnal secretion patterns with prevalence of type 2 diabetes and HbA1c levels as well as the potential impact of sex and adiposity on this association.
  
  
  
  A cross-sectional analysis was conducted among 757 participants (aged 65-90 years) of the population-based KORA (Cooperative Health Research in the Region of Augsburg)-Age study. Multivariate regression analyses were employed to examine the association between salivary cortisol (measured upon waking (M1), 30min after awakening (M2), and in the late night (LNSC)) and type 2 diabetes as well as glycated hemoglobin (HbA1c) with adjustments for potential confounders.
  
  
  
  In the total sample population, an elevated LNSC level was observed in type 2 diabetes patients compared to non-patients (P=0.04). In sex-stratified analyses, diabetic men showed a greater Cortisol Awakening Response (CAR) (P=0.02). Diabetic women had significantly elevated LNSC levels (P=0.04). HbA1c was positively associated with both CAR and LNSC levels but was negatively associated with M1 to LNSC ratio.
  
  
  
  In this aged population, type 2 diabetes is associated with dysregulated cortisol secretion characterized by distinct sex specific diurnal patterns.
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (HMGU), Neuherberg, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
authors.forename: Hamimatunnisa
authors.initials: H
authors.lastname: Johar
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (HMGU), Neuherberg, Germany; Department of Epidemiology, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, USA.
authors.forename: Rebecca Thwing
authors.initials: RT
authors.lastname: Emeny
authors.affiliation: Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bidlingmaier
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University of Giessen and Marburg, Gießen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kruse
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (HMGU), Neuherberg, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Electronic address: ladwig@helmholtz-muenchen.de.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Ladwig
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002940:Circadian Rhythm / Q000502:physiology; D003430:Cross-Sectional Studies / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000378:metabolism* / Q000503:physiopathology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008297:Male; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D012044:Regression Analysis; D012463:Saliva / Q000737:chemistry; D012737:Sex Factors
chemical_list: D006442:Glycated Hemoglobin; D006854:Hydrocortisone; C517652:hemoglobin A1c protein, human
keywords: Cortisol; Elderly; Epidemiology; HPA axis; HbA1c; Type 2 diabetes