Acute Psychological Stress Affects Glucose Concentrations in Patients With Type 1 Diabetes Following Food Intake but not in the Fasting State

Abstract

OBJECTIVE -To compare the effect of acute psychosocial stress on glucose concentrations in the fasting state and following food intake in patients with type 1 diabetes.RESEARCH DESIGN AND METHODS -In study 1, 20 patients were exposed to moderate psychosocial stress by means of the Trier Social Stress Test (TSST) in the fasting state. In study 2, the TSST was applied to 20 additional patients 75 min after intake of a standard meal. Glucose concentrations (by continuous glucose monitoring system), blood pressure, and heart rate were monitored on the control day and on the stress testing day.RESULTS -In both studies, blood pressure increased in response to TSST from 122/77 Ϯ 14/9 mmHg at baseline to a maximum of 152/93 Ϯ 21/13 mmHg (P Ͻ 0.001), and heart rate increased from 80 Ϯ 11 to 99 Ϯ 19 bpm (P Ͻ 0.001). In the fasting state (study 1), glucose concentrations remained unchanged during the control day as well as during the stress testing day. In study 2, glucose concentrations were similar on both days before and up to 75 min after the intake of the standard meal. However, a significant delay (of 45 min) in the decrease of glucose concentrations was induced by psychological stress. A two-factor repeated-measures ANOVA revealed a significant difference of glucose concentrations over time (F ϭ 646.65/P Ͻ 0.001).CONCLUSIONS -In the postprandial period, acute psychological stress induced a significantly delayed decrease of glucose concentrations, whereas in the fasting state, no effect on poststress glucose concentrations was observed. Diabetes Care 28:1910 -1915, 2005P atients with type 1 diabetes often complain of unexplained glucose excursions. Among other factors, variability in the absorption of insulin preparations and psychological stress may be of importance (2,3). Chronic psychological stress has been associated with higher levels of glycosylated hemoglobin (A1C) (4 -6). In contrast, the effect of acute psychological stress on glucose concentrations in patients with type 1 diabetes is less conclusive, with most studies showing no effect and others resulting in increased or even decreased glucose concentrations (5,7-15). In one previous study (5), the stress task was specifically applied in the postprandial state and was considered to have no effect, although the time course of glucose concentrations was altered. An additional study investigated patients on a glucose and insulin infusion in the fasting state. Since the insulin infusion rate was reduced at the beginning of the stress test, glucose concentrations were rising during the stress period, and an impaired insulin sensitivity following mental stress was found (15).A previous study (16) in healthy men showed a significantly more pronounced cortisol response to psychological stress following an oral glucose load compared with the cortisol response in the fasting state. Since an increase in cortisol levels in patients with type 1 diabetes may cause elevated glucose concentrations, the effect of acute psychological stress on glucose concentrations may cr...

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