Skip to main content
SpringerLink
Log in

Psychosocial Stress Predicts Abnormal Glucose Metabolism: The Australian Diabetes, Obesity and Lifestyle (AusDiab) Study

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

The evidence supporting a relationship between stress and diabetes has been inconsistent.

Purpose

This study examined the effects of stress on abnormal glucose metabolism, using a population-based sample of 3,759, with normoglycemia at baseline, from the Australian Diabetes, Obesity and Lifestyle study.

Methods

Perceived stress and stressful life events were measured at baseline, with health behavior and anthropometric information also collected. Oral glucose tolerance tests were undertaken at baseline and 5-year follow-up. The primary outcome was the development of abnormal glucose metabolism (impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes), according to WHO 1999 criteria.

Results

Perceived stress predicted incident abnormal glucose metabolism in women but not men, after multivariate adjustment. Life events showed an inconsistent relationship with abnormal glucose metabolism.

Conclusions

Perceived stress predicted abnormal glucose metabolism in women. Healthcare professionals should consider psychosocial adversity when assessing risk factor profiles for the development of diabetes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:4-14.

    Article  PubMed  CAS  Google Scholar 

  2. Magliano DJ, Barr ELM, Zimmet PZ, et al. Glucose indices, health behaviors, and incidence of diabetes in Australia. Diabetes Care. 2008;31:267-272.

    Article  PubMed  Google Scholar 

  3. Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular diseases. Ann Rev Pub Health. 2005;26:469-500.

    Article  Google Scholar 

  4. Rozanski A, Blumenthal JA, Davidson KW, Saab PG, Kubzansky L. The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: The emerging field of behavioral cardiology. J Am Coll Cardiol. 2005;45:637-651.

    Article  PubMed  Google Scholar 

  5. Grundy SM, Benjamin IJ, Burke GL, et al. Diabetes and cardiovascular disease: A statement for healthcare professionals from the American Heart Association. Circulation. 1999;100:1134-1146.

    Article  PubMed  CAS  Google Scholar 

  6. Eriksson AK, Ekbom A, Granath F, et al. Psychological distress and risk of pre-diabetes and type 2 diabetes in a prospective study of Swedish middle-aged men and women. Diabet Med. 2008;25:834-842.

    Article  PubMed  Google Scholar 

  7. Knol M, Twisk J, Beekman A, et al. Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia. 2006;49:837-845.

    Article  PubMed  CAS  Google Scholar 

  8. Mezuk B, Eaton WW, Albrecht S, Golden SH. Depression and type 2 diabetes over the lifespan: A meta-analysis. Diabetes Care. 2008;31:2383-2390.

    Article  PubMed  Google Scholar 

  9. Norberg M, Stenlund H, Lindahl B, et al. Work stress and low emotional support is associated with increased risk of future type 2 diabetes in women. Diabetes Res Clin Pract. 2007;76:368-377.

    Article  PubMed  CAS  Google Scholar 

  10. Lazarus R, Folkman S. Stress, appraisal and coping. New York: Springer; 1984.

    Google Scholar 

  11. Puterman E, Adler N, Matthews KA, Epel E. Financial strain and impaired fasting glucose: The moderating role of physical activity in the coronary artery risk development in young adults study. Psychosom Med. 2012;74:187-192.

    Article  PubMed  Google Scholar 

  12. Agardh EE, Ahlbom A, Andersson T, et al. Work stress and low sense of coherence is associated with type 2 diabetes in middle-aged Swedish women. Diabetes Care. 2003;26:719-724.

    Article  PubMed  Google Scholar 

  13. Heraclides A, Chandola T, Witte DR, Brunner EJ. Psychosocial stress at work doubles the risk of type 2 diabetes in middle-aged women. Diabetes Care. 2009;32:2230-2235.

    Article  PubMed  Google Scholar 

  14. Heraclides AM, Chandola T, Witte DR, Brunner EJ. Work stress, obesity and the risk of type 2 diabetes: Gender-specific bidirectional effect in the Whitehall II study. Obesity. 2011;20:428-433.

    Article  PubMed  Google Scholar 

  15. Kawakami N, Araki S, Takatsuka N, Shimizu H, Ishibashi H. Overtime, psychosocial working conditions, and occurrence of non-insulin dependent diabetes mellitus in Japanese men. J Epidemiol Comm Health. 1999;53:359-363.

    Article  CAS  Google Scholar 

  16. Kroenke CH, Spiegelman D, Manson J, et al. Work characteristics and incidence of type 2 diabetes in women. Am J Epidemiol. 2007;165:175-183.

    Article  PubMed  Google Scholar 

  17. Kumari M, Head J, Marmot M. Prospective study of social and other risk factors for incidence of type 2 diabetes in the Whitehall II study. Arch Intern Med. 2004;164:1873-1880.

    Article  PubMed  Google Scholar 

  18. Xu W, Hang J, Gao W, et al. Association between effort–reward imbalance and glycosylated hemoglobin (HbA1c) among Chinese workers: Results from SHISO study. Int Arch Occup Environ Health. 2012;85:215-220.

    Article  PubMed  CAS  Google Scholar 

  19. Kato M, Noda M, Inoue M, Kadowaki T, Tsugane S. Psychological factors, coffee and risk of diabetes mellitus among middle-aged Japanese: A population-based prospective study in the JPHC study cohort. Endocr J. 2009;56:459-468.

    Article  PubMed  Google Scholar 

  20. Rod NH, Gronbaek M, Schnohr P, Prescott E, Kristensen TS. Perceived stress as a risk factor for changes in health behaviour and cardiac risk profile: A longitudinal study. J Intern Med. 2009;266:467-475.

    Article  PubMed  Google Scholar 

  21. Siegrist J, Peter R, Junge A, Cremer P, Seidel D. Low status control, high effort at work and ischemic heart disease: Prospective evidence from blue-collar men. Soc Sci Med. 1990;31:1127-1134.

    Article  PubMed  CAS  Google Scholar 

  22. Landsbergis PA, Schnall PL, Warren K, Pickering TG, Schwartz JE. Association between ambulatory blood pressure and alternative formulations of job strain. Scand J Work Environ Health. 1994;20:349-363.

    Article  PubMed  CAS  Google Scholar 

  23. Cosgrove MP, Sargeant LA, Caleyachetty R, Griffin SJ. Work-related stress and type 2 diabetes: Systematic review and meta-analysis. Occup Med. 2012;62:167-173.

    Article  CAS  Google Scholar 

  24. Toker S, Shirom A, Shapira I, Berliner S, Melamed S. The association between burnout, depression, anxiety, and inflammation biomarkers: C-reactive protein and fibrinogen in men and women. J Occup Health Psychol. 2005;10:344-362.

    Article  PubMed  Google Scholar 

  25. Hallman T, Burell G, Setterlind S, Odén A, Lisspers J. Psychosocial risk factors for coronary heart disease, their importance compared with other risk factors and gender differences in sensitivity. J Cardiovasc Risk. 2001;8:39-49.

    Article  PubMed  CAS  Google Scholar 

  26. Almeida DM. Resilience and vulnerability to daily stressors assessed via diary methods. Curr Dir Psychol Sci. 2005;14:64-68.

    Article  Google Scholar 

  27. Mooy JM, de Vries H, Grootenhuis PA, Bouter LM, Heine RJ. Major stressful life events in relation to prevalence of undetected type 2 diabetes: The Hoorn study. Diabetes Care. 2000;23:197-201.

    Article  PubMed  CAS  Google Scholar 

  28. Toshihiro M, Saito K, Takikawa S, et al. Psychosocial factors are independent risk factors for the development of type 2 diabetes in Japanese workers with impaired fasting glucose and/or impaired glucose tolerance1. Diabet Med. 2008;25:1211-1217.

    Article  PubMed  CAS  Google Scholar 

  29. Räikkönen K, Matthews KA, Kuller LH. Depressive symptoms and stressful life events predict metabolic syndrome among middle-aged women. Diabetes Care. 2007;30:872-877.

    Article  PubMed  Google Scholar 

  30. Dunstan DW, Zimmet PZ, Welborn TA, et al. The Australian diabetes, obesity and lifestyle study (AusDiab)—Methods and response rates. Diabetes Res Clin Pract. 2002;57:119-129.

    Article  PubMed  Google Scholar 

  31. Australian Institute of Health and Welfare. The Active Australia Survey: A Guide and Manual for Implementation, Analysis and Reporting. Canberra: Australian Institute of Health and Welfare; 2003.

    Google Scholar 

  32. Australian Institute of Health and Welfare. Standard questions on the use of tobacco among adults. Canberra: Australian Institute of Health and Welfare; 1998.

    Google Scholar 

  33. Ireland P, Jolley D, Giles G, et al. Development of the Melbourne FFQ: A food frequency questionnaire for use in an Australian prospective study involving an ethnically diverse cohort. Asia Pac J Clin Nutr. 1994;3:19-31.

    Google Scholar 

  34. Dunstan DW, Salmon J, Owen N, et al. Associations of TV viewing and physical activity with the metabolic syndrome in Australian adults. Diabetologia. 2005;48:2254-2261.

    Article  PubMed  CAS  Google Scholar 

  35. Levenstein S, Prantera C, Varvo V, et al. Development of the perceived stress questionnaire: A new tool for psychosomatic research. J Psychosom Res. 1993;37:19-32.

    Article  PubMed  CAS  Google Scholar 

  36. Fliege H, Rose M, Arck P, et al. The Perceived Stress Questionnaire (PSQ) reconsidered: Validation and reference values from different clinical and healthy adult samples. Psychosom Med. 2005;67:78-88.

    Article  PubMed  Google Scholar 

  37. Caldwell JR, Theisen V, Kaunisto CA, et al. Psychosocial factors influence control of moderate and severe hypertension. Soc Sci Med. 1983;17:773-782.

    Article  PubMed  CAS  Google Scholar 

  38. World Health Organisation. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus. Geneva; 1999

  39. Pouwer F, Kupper N, Adriaanse MC. Does emotional stress cause type 2 diabetes mellitus? A review from the European Depression in Diabetes (EDID) Research Consortium. Discov Med. 2010;9:112-118.

    PubMed  Google Scholar 

  40. Kanner AD, Coyne JC, Schaefer C, Lazarus RS. Comparison of two modes of stress measurement: Daily hassles and uplifts versus major life events. J Behav Med. 1981;4:1-39.

    Article  PubMed  CAS  Google Scholar 

  41. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385-396.

    Article  PubMed  CAS  Google Scholar 

  42. Engum A. The role of depression and anxiety in onset of diabetes in a large population-based study. J Psychosom Res. 2007;62:31-38.

    Article  PubMed  Google Scholar 

  43. Kawakami N, Takatsuka N, Shimizu H, Ishibashi H. Depressive symptoms and occurrence of type 2 diabetes among Japanese men. Diabetes Care. 1999;22:1071-1076.

    Article  PubMed  CAS  Google Scholar 

  44. Chida Y, Hamer M. An association of adverse psychosocial factors with diabetes mellitus: A meta-analytic review of longitudinal cohort studies. Diabetologia. 2008;51:2168-2178.

    Article  PubMed  CAS  Google Scholar 

  45. Melamed S, Shirom A, Toker S, Shapira I. Burnout and risk of type 2 diabetes: A prospective study of apparently healthy employed persons. Psychosom Med. 2006;68:863-869.

    Article  PubMed  Google Scholar 

  46. Björntorp P. Body fat distribution, insulin resistance, and metabolic diseases. Nutrition. 1997;13:795-803.

    Article  PubMed  Google Scholar 

  47. Lloyd C, Smith J, Weinger K. Stress and diabetes: A review of the links. Diabetes Spectr. 2005;18:121-127.

    Article  Google Scholar 

  48. Dandona P, Aljada A, Bandyopadhyay A. Inflammation: The link between insulin resistance, obesity and diabetes. Trends Immunol. 2004;25:4-7.

    Article  PubMed  CAS  Google Scholar 

  49. Golden SH, Lazo M, Carnethon M, et al. Examining a bidirectional association between depressive symptoms and diabetes. JAMA. 2008;299:2751-2759.

    Article  PubMed  Google Scholar 

  50. Christenfeld N, Gerin W, Linden W, et al. Social support effects on cardiovascular reactivity: Is a stranger as effective as a friend? Psychosom Med. 1997;59:388-398.

    PubMed  CAS  Google Scholar 

  51. Grant N, Hamer M, Steptoe A. Social isolation and stress-related cardiovascular, lipid, and cortisol responses. Ann Behav Med. 2009;37:29-37.

    Article  PubMed  Google Scholar 

  52. Abdul-Ghani MA, Tripathy D, DeFronzo RA. Contributions of β-cell dysfunction and insulin resistance to the pathogenesis of impaired glucose tolerance and impaired fasting glucose. Diabetes Care. 2006;29:1130-1139.

    Article  PubMed  CAS  Google Scholar 

  53. Compas B, Slavin L, Wagner B, Vannatta K. Relationship of life events and social support with psychological dysfunction among adolescents. J Youth Adolesc. 1986;15:205-221.

    Article  Google Scholar 

Download references

Acknowledgments

EDW is supported by a Diabetes UK Fellowship (09/0003833). DJM is supported by the Victorian Cancer Agency Fellowship for 2011–2012. RJT is supported by a Senior Research Lions Foundation fellowship. JES is supported by a National Health and Medical Research Council Fellowship (586623). The AusDiab study, co-coordinated by the Baker IDI Heart and Diabetes Institute, gratefully acknowledges the generous support given by the: National Health and Medical Research Council (NHMRC grant 233200), Australian Government Department of Health and Ageing, Abbott Australasia Pty Ltd, Alphapharm Pty Ltd, AstraZeneca, Bristol-Myers Squibb, City Health Centre-Diabetes Service-Canberra, Department of Health and Community Services-Northern Territory, Department of Health and Human Services-Tasmania, Department of Health-New South Wales, Department of Health-Western Australia, Department of Health-South Australia, Department of Human Services-Victoria, Diabetes Australia, Diabetes Australia Northern Territory, Eli Lilly Australia, Estate of the Late Edward Wilson, GlaxoSmithKline, Jack Brockhoff Foundation, Janssen-Cilag, Kidney Health Australia, Marian & FH Flack Trust, Menzies Research Institute, Merck Sharp & Dohme, Novartis Pharmaceuticals, Novo Nordisk Pharmaceuticals, Pfizer Pty Ltd, Pratt Foundation, Queensland Health, Roche Diagnostics Australia, Royal Prince Alfred Hospital, Sydney, Sanofi Aventis, and Sanofi Synthelabo. The AusDiab study was also supported in part by the Victorian Government’s OIS Program. For their invaluable contribution to the AusDiab setup and field activities, we are enormously grateful to A. Allman, B. Atkins, S. Bennett, A. Bonney, S. Chadban, M. de Courten, M. Dalton, D. Dunstan, T. Dwyer, H. Jahangir, D. Jolley, D. McCarty, A. Meehan, N. Meinig, S. Murray, K. O’Dea, K. Polkinghorne, P. Phillips, C. Reid, A. Stewart, R. Tapp, H. Taylor, T. Whalen, F. Wilson, and P Zimmet.

Conflict of Interest

The authors have no conflict of interest to disclose.

Author information

Authors and Affiliations

  1. School of Public Health and Preventive Medicine, Alfred Hospital, Monash University, 89 Commercial Road, Melbourne, VIC, 3004, Australia

    Emily D. Williams Ph.D. & Brian F. Oldenburg Ph.D.

  2. International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK

    Emily D. Williams Ph.D.

  3. Baker IDI Heart and Diabetes Institute, Melbourne, Australia

    Dianna J. Magliano Ph.D. & Jonathan E. Shaw MD, FRACP, FRCP

  4. National Vision Research Institute, Australian College of Optometry, Melbourne, Australia

    Robyn J. Tapp Ph.D.

Authors
  1. Emily D. Williams Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dianna J. Magliano Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robyn J. Tapp Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brian F. Oldenburg Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jonathan E. Shaw MD, FRACP, FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emily D. Williams Ph.D..

About this article

Cite this article

Williams, E.D., Magliano, D.J., Tapp, R.J. et al. Psychosocial Stress Predicts Abnormal Glucose Metabolism: The Australian Diabetes, Obesity and Lifestyle (AusDiab) Study. ann. behav. med. 46, 62–72 (2013). https://doi.org/10.1007/s12160-013-9473-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12160-013-9473-y

Keywords

Search

Navigation