Category: Diabetes

Why Stress May Raise Type 2 Diabetes Risk in Women

Traditional risk factors like obesity, high blood pressure, and a sedentary & nonactive lifestyle may not be the sole risk factors that can predict type 2 diabetes, as newly emerging research highlights the critical role that stress may play in the development of the condition: specifically in women.

The study, which will be presented on November 10th at the American Heart Association’s Scientific Sessions conference in Chicago, found that increasing stress stemming from traumatic events—in addition to long-term situations at home or work—was associated with ‘an almost two-fold higher risk of new type 2 diabetes cases among older women.’

Jonathan Butler, the study’s lead researcher and a postdoctoral scholar at the University of California, San Francisco’s Center for the Study of Adversity and Cardiovascular Disease, stressed the importance of taking psychosocial stressors as risk factors for diabetes “as seriously as other embraced diabetes risk factors.” Given the fact that diabetes has rapidly become one of the most serious public health issues, impacting approximately 30.3 million Americans according to data from the Centers for Disease Control and Prevention, it becomes even more imperative to “better understand risk factors for diabetes in this group,” said Butler: particularly given the fact that a majority of these people are older women.

Dr. Sherita Hill Golden, professor of medicine at the Johns Hopkins University School of Medicine in Baltimore, echoed Butler’s sentiments regarding looking beyond traditional physiological risk factors. “We’ve been trying to understand the relationship between stress, mental health and diabetes risk for a while,” as additional evidence suggests that psychosocial stress, and the ways in which people cope with stressors, may impact overall cardiometabolic health.

While previous studies focused on the relationship and correlation between stress and diabetes have focused on individual stressors, i.e. work, or symptoms of depression or anxiety, Butler and his colleagues designed a study that investigated “the joint relationship of multiple stressors with diabetes risk among women over time.”

The data included 22,706 female health professionals, all of whom who did not have cardiovascular disease; the average age of the participant was 72. Researchers collected information regarding “acute and chronic stressors and then followed the women for an average of three years.” The definitions of acute stress included both negative and traumatic life events, while chronic stress was generally related to family, work, finances, relationship, discrimination, etc. The women that had the highest levels of both acute and chronic stress presented with nearly double the risk for diabetes.

Dr. Michelle A. Albert, the study’s senior author and a professor of medicine at the University of California, San Francisco, states that the next steps will be to not only confirm the findings, but also to determine specific techniques & strategies “targeted at psychosocial stressors” that could potentially lessen, or decrease, diabetes risk in older women. She additionally communicated the importance of health care providers and clinicians inquiring about psychosocial stressors, as part of their assessment of diabetes risk, from a public health perspective.

Golden additionally stated that the new findings highlight the importance of considering the role of non-traditional risk factors, such as stress, in the development of diabetes. “We know that lifestyle intervention works for diabetes prevention, but that can be challenging if people experience cumulative stressors, like losing a job or caring for a family member, that hinder them from engaging in healthy behaviors like exercising, eating right or smoking cessation,” she said. “It’s important to assess and understand a patient’s social history. They may need a referral to a counselor or social worker.”


“Type 1.5 Diabetes” Study Links Immune and Metabolic Disease

A condition termed latent autoimmune diabetes in adults (LADA) is often ignored—as most people, when considering diabetes, think of type 1 or type 2. Type 1 diabetes develops during childhood, when the body is incapable of producing necessary insulin; type 2 diabetes, the most pervasive and commonly diagnosed, is most commonly diagnosed in adulthood, and occurs when the body has a learned resistance to insulin. Yet the third, hybrid form begins to develop in adulthood, and the symptoms are caused by the body not producing insulin: as opposed to a learned resistance. Given that this type encompasses both type 1 and type 2, many clinicians refer to it as type 1.5.

Recently, scientists at the Children’s Hospital of Philadelphia (CHOP) have performed the largest-ever genetic study of this type of diabetes, and discovered new connections to the other major types of diabetes. These new insights and findings likely offer more accurate diagnosis, better treatment, and more precise research surrounding the puzzling condition. The research, which appeared online September 25th in the journal Diabetes Care, revealed clues regarding the genetic influences of LADA. Diana L. Cousminer, PhD, a geneticist at CHOP, stated: “This study lends support to the idea that LADA is a hybrid of type 1 and type 2 diabetes, but doesn’t settle the question of the best way to precisely define the disorder. Correctly characterizing LADA is important, because it may determine whether a patient receives the most appropriate treatment.”

The research represents the first genome-wide association study of LADA, including an international effort: with dozens of co-authors from nine countries. Several of the authors had previously participated in a 2017 study that linked gene variants in LADA to those in T1D and T2D. Both studies determined that the strongest genetic signals in LADA were associated with T1D: the autoimmune form of diabetes that usually presents in childhood, and requires insulin treatment. The more recent analysis also found that genetic signals linked to T2D, the metabolic type of diabetes, more frequently appeared first in adults—and more commonly.

The team established that the strongest genetic signals in LADA were chiefly shared with previously established variants linked to T1D. Yet the researchers unearthed “a novel locus with genome-wide significance near the gene PFKFB3,” a gene that codes for a protein that regulates both insulin signaling and glycolisis, the chemical reaction that yields energy from glucose. Cousminer noted that this finding “points to how variants at PFKFB3 may help to drive LADA,” specifically because the gene’s product impacts both metabolism (a marker of T2D) and regulates inflammation in autoimmune disease (a chief feature in T1D). “This protein therefore appears to sit at the intersection of both major types of disease.”

Rajashree Mishra, co-first author of the current study from CHOP’s Division of Human Genetics and a graduate student in the Perelman School of Medicine at the University of Pennsylvania, notes: “Further study of underlying genetic interactions in LADA may reveal better biomarkers of the disease. Currently, as high as 5 to 10 percent of patients diagnosed as adults with type 2 diabetes may actually be misdiagnosed, and in fact have a late-onset form of autoimmune diabetes. More accurate diagnosis may guide better clinical management. For instance, patients with LADA may require close monitoring, to detect the optimal point at which they require insulin.”