Psychological stress is common in many physical illnesses and is increasingly recognized as a risk factor for disease onset and progression. An emerging body of literature suggests that stress has a role in the aetiology of type 2 diabetes mellitus (T2DM) both as a predictor of new onset T2DM and as a prognostic factor in people with existing T2DM. Here, we review the evidence linking T2DM and psychological stress. We highlight the physiological responses to stress that are probably related to T2DM, drawing on evidence from animal work, large epidemiological studies and human laboratory trials. We discuss population and clinical studies linking psychological and social stress factors with T2DM, and give an overview of intervention studies that have attempted to modify psychological or social factors to improve outcomes in people with T2DM.

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Psychological stress-related processes are thought to contribute to the development and progression of type 2 diabetes, but the biological mechanisms involved are poorly understood. Here, we tested the notion that people with type 2 diabetes experience chronic allostatic load, manifest as dynamic disturbances in reactivity to and recovery from stress across multiple (cardiovascular, neuroendocrine, inflammatory, metabolic) biological systems, coupled with heightened experience of chronic life stress. We carried out an experimental comparison of 140 men and women aged 50-75 y with type 2 diabetes and 280 nondiabetic individuals matched on age, sex, and income. We monitored blood pressure (BP) and heart rate, salivary cortisol, plasma interleukin (IL)-6, and total cholesterol in response to standardized mental stress, and assessed salivary cortisol over the day. People with type 2 diabetes showed impaired poststress recovery in systolic and diastolic BP, heart rate and cholesterol, and blunted stress reactivity in systolic BP, cortisol, cholesterol, and IL-6. Cortisol and IL-6 concentrations were elevated, and cortisol measured over the day was higher in the type 2 diabetes group. Diabetic persons reported greater depressive and hostile symptoms and greater stress experience than did healthy controls. Type 2 diabetes is characterized by disruption of stress-related processes across multiple biological systems and increased exposure to life stress. Chronic allostatic load provides a unifying perspective with implications for etiology and patient management.ype 2 diabetes has a heterogeneous pathophysiology in which β-cell dysfunction and insulin resistance play pivotal roles (1). Stress-related factors may contribute to risk of type 2 diabetes through their impact on inflammatory, metabolic, cardiovascular, and neuroendocrine regulation (2). Socioeconomic adversity over the life course predicts type 2 diabetes in later life (3), whereas stress at work and more general indicators of perceived stress are associated with future diabetes (4, 5). There appears to be a bidirectional relationship between type 2 diabetes and depressive symptoms (6), and people with type 2 diabetes may report greater social isolation and more limited social support (7).These diverse associations between stress-related processes and diabetes are only partly accounted for by lifestyle factors such as physical inactivity, alcohol consumption, or adiposity, suggesting that direct psychobiological pathways may be involved. A helpful concept in this regard is allostatic load. Allostasis refers to the dynamic process of adaptation to environmental challenges through adjustments in multiple biological systems, including the hypothalamic-pituitary-adrenocortical (HPA) axis, autonomic nervous system, and metabolic and immune systems (8). Allostasis is essential for maintaining homeostasis, but repeated or sustained stimulation leads to allostatic load, the wear-and-tear that results from dysregulation of mediating processes. Allostatic load is freque...

In this nonclinical population, T2D was associated with a flatter slope in cortisol levels across the day and raised bedtime cortisol values.

In this nonclinical population, alterations in diurnal cortisol patterns were predictive of future glucose disturbance.

Background Age discrimination (or ageism) is pervasive in society. Other forms of discrimination (such as racism) have been linked with adverse health outcomes, but age discrimination has not been well studied in public health. We aimed to examine associations between perceived age discrimination and health and wellbeing in England. Methods We did a longitudinal observational population study with data from the English Longitudinal Study of Ageing, a nationally representative sample of older men and women. Participants were aged 50 years or older and reported experiences of age discrimination via a face-to-face computer-assisted personal interview and a self

Background Physical and cognitive function decline with age. Slow walking speed has been associated with negative health outcomes and dementia is often preceded by cognitive decline. This study investigated walking speed, cognitive function and the interaction between changes in these measures in relation to dementia risk. Method Walking speed and cognition were assessed in 3,932 individuals aged ≥60 years at wave 1 (2002–03) and 2 (2004–05) of the English Longitudinal Study of Ageing. New dementia cases were assessed from wave 3 (2006–07) to wave 7 (2014–15). The associations were modelled using Cox proportional hazards regression. Results Participants with faster baseline walking speeds (HR 0.36; 95% CI 0.22 – 0.60) had a decreased risk of dementia. Those who had a greater decline in walking speed (waves 1 – 2 (HR 1.23; 95% CI 1.03 – 1.47) had an increased dementia risk. Participants with greater baseline cognition (HR 0.42; 95% CI 0.34 – 0.54) had a reduced dementia risk. Those who had a greater decline in cognition (waves 1–2) had a greater risk of dementia (HR 1.78; 95% CI 1.53 – 2.06). Change in walking speed and change in cognition did not interact significantly in relation to dementia risk (HR 1.01; 95% CI 0.88 – 1.17). Conclusions In this community-dwelling sample of English adults those with slower walking speeds and a greater decline in speed over time had an increased risk of developing dementia independent of changes in cognition. Further research is required to understand the mechanisms that may drive these associations.

Background Social engagement protects against dementia onset. Less is known about patterns of social engagement around the time of dementia diagnosis. We investigated face-to-face and telephone contact at three times (pre-diagnosis, at report of diagnosis, 2 years post-diagnosis) in individuals who developed dementia and a comparison group. Methods Social engagement was assessed at waves 2–7 of the English Longitudinal Study of Ageing in 4171 individuals aged 50 and older. Dementia was ascertained by either self-reported physician diagnosis or through an informant evaluation of a participant’s functional and cognitive performance compared with a few years earlier. Generalized estimating equations were used to examine differences by group, time, and group-by-time interactions. Results The dementia group reported less face-to-face ( p < 0.001) and telephone contact ( p < 0.001) than the dementia-free group pre-diagnosis. The dementia group experienced greater reductions in social engagement leading up to dementia diagnosis and in the 2 years following diagnosis ( p’s < 0.001). Conclusion Given that social engagement reduces dementia risk and supports the lived experience of people with dementia, it is important to find ways of promoting social interaction in older adults.