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Acute Psychological Stress Affects Glucose Concentrations in Patients With Type 1 Diabetes Following Food Intake but not in the Fasting State

¹ Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital of Zurich, Zurich, Switzerland
² Department of Internal Medicine, Medical Policlinic, University Hospital of Zurich, Zurich, Switzerland
³ Division of Psychosocial Medicine, University Hospital of Zurich, Zurich, Switzerland
⁴ Department of Biostatistics, University of Zurich, Zurich, Switzerland

Address correspondence and reprint requests to Peter Wiesli, MD, Department of Internal Medicine, Division of EndocrinologyDiabetes, University Hospital of Zurich, CH-8091 Zurich, Switzerland. E-mail: peter.wiesli{at}usz.ch

OBJECTIVE—To compare the effect of acute psychosocial stress on glucose concentrations in the fasting state and following food intake in patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS—In study 1, 20 patients were exposed to moderate psychosocial stress by means of the Trier Social Stress Test (TSST) in the fasting state. In study 2, the TSST was applied to 20 additional patients 75 min after intake of a standard meal. Glucose concentrations (by continuous glucose monitoring system), blood pressure, and heart rate were monitored on the control day and on the stress testing day.

RESULTS—In both studies, blood pressure increased in response to TSST from 122/77 ± 14/9 mmHg at baseline to a maximum of 152/93 ± 21/13 mmHg (P < 0.001), and heart rate increased from 80 ± 11 to 99 ± 19 bpm (P < 0.001). In the fasting state (study 1), glucose concentrations remained unchanged during the control day as well as during the stress testing day. In study 2, glucose concentrations were similar on both days before and up to 75 min after the intake of the standard meal. However, a significant delay (of 45 min) in the decrease of glucose concentrations was induced by psychological stress. A two-factor repeated-measures ANOVA revealed a significant difference of glucose concentrations over time (F = 646.65/P < 0.001).

CONCLUSIONS—In the postprandial period, acute psychological stress induced a significantly delayed decrease of glucose concentrations, whereas in the fasting state, no effect on poststress glucose concentrations was observed.

Abbreviations: CGMS, continuous glucose monitoring system • TSST, Trier Social Stress Test

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Stress and Type 1 Diabetes

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