Effect of Acute Psychological Stress on Glucose Concentrations in Patients With Type 2 Diabetes
Condition: Type 2 Diabetes
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 2; Stress, Psychological
Study type: Interventional

Summary: 
      The study is designed to evaluate the effects of acute psychological stress on blood glucose
      levels. We will study one group of patients in the fasting state on a control day and a
      stress test day, another group will undergo the same protocol in the postprandial state.
    

Detailed description: 
      Patients with type 2 diabetes often complain about changing blood glucose levels in times of
      emotional or mental stress, most subject's self-reporting higher blood glucose measurements
      in stressful conditions. To daily distress in diabetes additional emotional or mental stress
      can add a further momentum to destabilize glucose levels due to the adrenocortical response
      with enhancing insulin resistance and decreasing the endogenous insulin secretion. Another
      physiological link between stress and diabetes might be a higher sensitivity of the
      hypothalamo-pituitary-adrenal axis, leading to antagonizing effects on insulin actions. A
      study in type 2 diabetes demonstrated that stressors can destabilize blood glucose levels.
      Stress levels in diabetes have been shown to have a relationship to diabetic complications.
      Previous studies of psychological stress in type 1 diabetes have shown no effect of elevated
      catecholamine levels after short-lived psychological stimuli on glucose levels, but a
      significantly delayed decrease of glucose concentrations after an acute psychological stress
      in the postprandial state in association with elevated cortisol levels, showing no change of
      glucose concentration in the fasting state. This was in contrast to previous data in healthy
      subjects, showing that low glucose levels before a psychological stress prevented the
      stress-induced activation of the hypothalamus pituitary adrenal axis, but postprandial higher
      blood glucose levels induced a large cortisol response. These findings of a different
      cortisol responses in the fasting or fed status in healthy or absolute insulin deficient
      subjects could also be relevant for glucose metabolism in subjects with type 2 diabetes.

      The effect of an acute psychological stress on glucose concentration may critically depend on
      whether stress is applied in the fasting or fed state. A different metabolic response to
      stress depending on food intake could explain different findings in other clinical trials and
      contribute to understanding glucose responses to stress. The aim of our study was thus to
      test whether the effect of acute psychological stress on glucose concentrations is different
      in the fasting compared to the fed state in type 2 diabetes.
    

Intervention name(s): Trier Social Stress Test (TSST)
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Educational/Counseling/Training
Keywords: glucose control in acute stress