Effect of Acute Psychotic Stress in Nondiabetic Subjects on β-Cell Function and Insulin Sensitivity
- Eli Shiloah, MD1,
- Shula Witz, MD2,
- Yehuda Abramovitch, MD2,
- Ohad Cohen, MD3,
- Andreas Buchs, MD14,
- Yoram Ramot, MD4,
- Mordechai Weiss, MD4,
- Abraham Unger, RN2 and
- Micha J. Rapoport, MD14
- 1Department of Internal Medicine “C,” Assaf Harofeh Medical Center, Zerifin, Israel
- 2Beer Yaacob Psychiatric Center, Tel-Aviv University, Israel
- 3Institute of Endocrinology Sheba Medical Center affiliated to Sackler School of Medicine, Tel-Aviv University, Israel
- 4Diabetes and Endocrinology Unit, Assaf Harofeh Medical Center, Zerifin, Israel
Abstract
OBJECTIVE—To determine the effect of acute psychotic stress on glucose homeostasis in nondiabetic subjects.
RESEARCH DESIGN AND METHODS—β-Cell function and insulin sensitivity were determined by the homeostasis model assessment in 39 nondiabetic patients with acute psychotic stress reaction admitted to a psychiatric ward. The clinical global impression (CGI) score was used to evaluate the level of psychological stress. Patients were assessed on admission, after 2 weeks, before discharge, and 6 months after discharge.
RESULTS—The mean CGI score decreased significantly with time: 5.3 ± 0.8 and 1.6 ± 0.7 on admission and predischarge, respectively (P < 0.001). This was associated with a significant reciprocal increase of mean β-cell function from 96.8 ± 33.2 to 134.4 ± 60% at admission and postdischarge, respectively (P < 0.003), and a decrease of mean insulin sensitivity from 101.7 ± 36 to 77.1 ± 34.8% (P < 0.001). In contrast, mean glucose and HbA1c levels did not change significantly. Subgroup analysis demonstrated that patients with the highest stress score on admission (≥6) had significantly higher glucose (P = 0.01) and insulin levels (P = 0.04) than patients with lower score (<6). Furthermore, insulin sensitivity and CGI score on admission were inversely correlated (r = −0.38, P < 0.02). In these patients, no correlation was found between β-cell function or insulin sensitivity and BMI.
CONCLUSIONS—These data indicate that β-cell function and insulin sensitivity are inversely correlated with acute psychotic stress.
Footnotes
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Address correspondence and reprint requests to M.J. Rapoport, MD, Department of Internal Medicine “C,” Assaf Harofeh Medical Center, Zerifin 70300, Israel. E-mail: mrapoport{at}asaf.health.gov.il.
Received for publication 13 October 2002 and accepted in revised form 24 January 2003.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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