Depression, smoking, physical inactivity and season independently associated with midnight salivary cortisol in type 1 diabetes

Abstract

BackgroundDisturbances of the circadian rhythm of cortisol secretion are associated with depression, coronary calcification, and higher all-cause and cardiovascular mortality.The primary aim of this study was to test the associations between midnight salivary cortisol (MSC), depression and HbA1c, and control for behavioural, environmental and intra individual factors with possible impact on cortisol secretion, like smoking, physical inactivity, season, medication, diabetes duration, severe hypoglycemia episodes, age and gender in patients with type 1 diabetes. Secondary aims were to present MSC levels for a reference group of non-depressed type 1 diabetes patients with a healthy life style (physically active and non-smoking), and to explore seasonal variations.MethodsA cross-sectional population based study of 196 patients (54% men and 46% women) aged 18–59 years that participated in a randomized controlled trial targeting depression in type 1 diabetes. Depression was assessed by the Hospital Anxiety and Depression Scale-depression subscale. MSC, HbA1c, serum-lipids, blood pressure, waist circumference and data from medical records and the Swedish National Diabetes Registry were collected.ResultsThirty four patients (17%) had MSC ≥9.3 nmol/L, which was associated with smoking (AOR 5.5), spring season (AOR 4.3), physical inactivity (AOR 3.9), self-reported depression (AOR 3.1), and older age (per year) (AOR 1.08). HbA1c >70 mmol/mol (>8.6%) (AOR 4.2) and MSC ≥9.3 nmol/L (AOR 4.4) were independently linked to self-reported depression. Season was strongly associated with MSC levels and no other variables studied showed seasonal variations. In a reference group of 137 non-depressed patients with a healthy life style (physically active, non-smoking) the median MSC level was 4.6 nmol/L (range 1.9–23.0).ConclusionsIn this study of patients with type 1 diabetes high MSC was linked to smoking, physical inactivity, depression, season and older age. Thus a high cortisol value identified three major targets for treatment in type 1 diabetes.

Temporal variation of diabetic ketoacidosis and hypoglycemia in adults with type 1 diabetes: A nationwide cohort study

“…Cortisol is a major contributor in the development of DKA and the December peak reported previously coincides with the period of highest risk for DKA in our study. However, in a study of people with T1D, temporal variation of midnight salivary cortisol was present, with the highest levels found in spring rather than winter . Other counter regulatory hormones were not assessed in that study and interestingly no seasonal changes in HbA1c were found, as in other studies …”

“…However, in a study of people with T1D, temporal variation of midnight salivary cortisol was present, with the highest levels found in spring rather than winter. 22 Other counter regulatory hormones were not assessed in that study 22 and interestingly no seasonal changes in HbA1c were found, as in other studies. 9,10,22 The temporal variations in hospitalizations for acute complications have important clinical implications.…”

“…22 Other counter regulatory hormones were not assessed in that study 22 and interestingly no seasonal changes in HbA1c were found, as in other studies. 9,10,22 The temporal variations in hospitalizations for acute complications have important clinical implications. For example, DKA is associated with high healthcare utilization and costs, with the average charge per DKA hospitalization in the US estimated to be between US$6444 and US$10 876.…”

Low levels of soluble TWEAK, indicating on-going inflammation, were associated with depression in type 1 diabetes: a cross-sectional study

“…We have previously demonstrated in these patients with T1D that depression was associated with anxiety and increased levels of midnight salivary cortisol secretion [28,29], but not with obesity [30], which indicates traits of melancholic depression [5]. The depressed patients did not exhibit lower levels of physical activity than the non-depressed [31] -as signs of lethargy -which is characteristic for atypical depression [5].…”

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“…Basally, smokers demonstrate altered sal-T and sal-C compared to controls [9,106,155]. Furthermore, English and colleagues [49] reported elevated levels of total, free, and bioavailable T in smokers compared with non-smokers.…”