Stress resilience and subsequent risk of type 2 diabetes in 1.5 million young men

Abstract

Aims/hypothesis Psychosocial stress in adulthood is associated with a higher risk of type 2 diabetes, possibly mediated by behavioural and physiological factors. However, it is unknown whether low stress resilience earlier in life is related to subsequent development of type 2 diabetes. We examined whether low stress resilience in late adolescence is associated with an increased risk of type 2 diabetes in adulthood. Methods We conducted a national cohort study of all 1,534,425 military conscripts in Sweden during 1969-1997 (97-98% of all 18-year-old men nationwide each year) without prior diagnosis of diabetes, who underwent standardised psychological assessment for stress resilience (on a scale of 1-9) and were followed up for type 2 diabetes identified from outpatient and inpatient diagnoses during 1987-2012 (maximum attained age 62 years). Results There were 34,008 men diagnosed with type 2 diabetes in 39.4 million person-years of follow-up. Low stress resilience was associated with an increased risk of developing type 2 diabetes after adjusting for BMI, family history of diabetes, and individual and neighbourhood socioeconomic factors (HR for lowest vs highest quintile: 1.51; 95% CI 1.46, 1.57; p<0.0001), including a strong linear trend across the full range of stress resilience (ptrend<0.0001). This association did not vary by BMI level, family history of diabetes or socioeconomic factors. Conclusions/interpretation These findings suggest that low stress resilience may play an important long-term role in aetiological pathways for type 2 diabetes. Further elucidation of the underlying causal factors may help inform more effective preventive interventions across the lifespan.

Life satisfaction is a protective factor against the onset of Type 2 diabetes in men but not in women: findings from the MONICA/KORA cohort study

“…Our findings are consistent with the present literature showing protective effects of psychological well‐being on diabetes and with further studies linking life satisfaction with survival benefit , fewer mobility limitations and decreased risk of dementia . To our knowledge, the current investigation is the first to demonstrate a protective effect of high life satisfaction on risk of incident Type 2 diabetes in men in a large community‐dwelling population.…”

ISPAD Clinical Practice Consensus Guidelines 2018: Psychological care of children and adolescents with type 1 diabetes

“…Additionally, maladaptive coping in youth has also been associated with poor regimen adherence . It has also been shown that resilience to stress is associated with better glycemic control and other diabetes outcomes including depressive symptoms, diabetes management, and quality of life …”

“…128,129 Additionally, maladaptive coping in youth has also been associated with poor regimen adherence. 130,131 It has also been shown that resilience to stress is associated with better glycemic control 132,133 and other diabetes outcomes including depressive symptoms, diabetes management, and quality of life. 124,134 Research addressing the Health Belief Model in adolescents indicate that beliefs related to the seriousness of diabetes, personal vulnerability to complications, costs of regimen adherence, and beliefs in the efficacy of treatment/mediation beliefs, have been associated with both regimen adherence and glycemic control.…”

Low stress resilience in late adolescence and risk of smoking, high alcohol consumption and drug use later in life

“…Large longitudinal register-based studies have linked low stress resilience in late adolescence with subsequent increased risk of coronary heart disease,6 ischaemic and haemorrhagic stroke,7 hypertension,8 heart failure9 and diabetes mellitus type 210 as well as with liver cancer and lung cancer 11. Stress-induced unfavourable health behaviours have been proposed as a main pathway in these associations, and evidence from cross-sectional studies have indicated that higher stress resilience may mitigate tendencies for smoking, nicotine dependence, life-time alcohol consumption and illicit drug use 12–15.…”