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Exp Clin Endocrinol Diabetes 2013; 121(07): 420-424
DOI: 10.1055/s-0033-1347246
Article
© Georg Thieme Verlag KG Stuttgart · New York

Glucose Control during a Driving Training in Patients with Type 1 and Type 2 Diabetes Mellitus – a Randomised, Controlled Trial

R. Truninger
1   Department of Internal Medicine, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
,
H. Uthoff
2   Department of Vascular and Interventional Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA and ­Department of Angiology, University Hospital of Basel, Basel, Switzerland
,
J. Capraro
1   Department of Internal Medicine, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
,
B. Frauchiger
1   Department of Internal Medicine, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
,
G. A. Spinas
3   Department of Endocrinology, Diabetes and Clinical Nutrition, University Hospital of Zurich, Zurich, Switzerland
,
P. Wiesli
1   Department of Internal Medicine, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
› Author Affiliations
Further Information

Publication History

received 23 February 2013
first decision 20 April 2013

accepted 15 May 2013

Publication Date:
13 June 2013 (online)

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Abstract

Aims:

To investigate the effect of prolonged acute mental stress by means of a driving training on glucose control in patients with type 1 and type 2 diabetes mellitus.

Methods:

39 patients with insulin-treated diabetes (18 type 1, 21 type 2 diabetes) were exposed to mental stress by means of a 2 h-driving training. The training session started 15 min after intake of a standard meal. Blood glucose, blood pressure, heart rate, salivary cortisol, and subjective stress perception were monitored in regular intervals and compared to a control day.

Results:

On the stress testing day, blood pressure rose from 142/86±16/9 mmHg to 162/95±22/11 mmHg (p<0.001), heart rate from 72±11 bpm to 86±16 bpm (p<0.001) and subjective stress perception from 1.4±0.6 to 4.7±2.5 points (p<0.001). Salivary cortisol concentrations increased from a median of 5.1 nmol/l (Interquartile Range (IQR) 3.5–7.5 nmol/l) at baseline to 7.7 nmol/l (IQR 4.7–12.8 nmol/l, p<0.001), all these measurements remained stable on the control day. Glucose control showed no significant difference on the stress testing day compared to the control day (mean difference over time=0.22 mmol/l, 95%-CI −1.5 to +1.9 mmol/l, p=0.794). A multivariate linear regression and correlation analysis showed no association of demographic characteristics (diabetes type, age, body mass index (BMI), diabetes duration, HbA1c), objective or subjective stress parameters with the course of glucose concentrations during the driving training.

Conclusions:

Although a 2 h-driving training causes increased subjective and objective stress parameters, glucose control is maintained in patients with insulin-treated diabetes.

Key words

acute mental stress - catecholamines - salivary cortisol - hypothalamo-pituitary adrenal axis - insulin resistance
 

  • References

  • 1 Lloyd CE, Dyer PH, Lancashire RJ et al. Association between stress and glycemic control in adults with type 1 (insulin-dependent) diabetes. Diabetes Care 1999; 22: 1278-1283
    CrossrefPubMedGoogle Scholar
  • 2 Hains AA, Berlin KS, Davies WH et al. Attributions of adolescents with type 1 diabetes in social situations: relationship with expected adherence, diabetes stress, and metabolic control. Diabetes Care 2006; 29: 818-822
    CrossrefPubMedGoogle Scholar
  • 3 Nakahara R, Yoshiuchi K, Kumano H et al. Prospective study on influence of psychosocial factors on glycemic control in Japanese patients with type 2 diabetes. Psychosomatics 2006; 47: 240-246
    CrossrefPubMedGoogle Scholar
  • 4 Lustman PJ, Anderson RJ, Freedland KE et al. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 2000; 23: 934-942
    CrossrefPubMedGoogle Scholar
  • 5 Black SA, Markides KS, Ray LA. Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care 2003; 26: 2822-2828
    CrossrefPubMedGoogle Scholar
  • 6 Lin EH, Rutter CM, Katon W et al. Depression and advanced complications of diabetes: a prospective cohort study. Diabetes Care 2010; 33: 264-269
    CrossrefPubMedGoogle Scholar
  • 7 Fujihara K, Saito A, Heianza Y et al. Impact of psychological stress caused by the Great East Japan Earthquake on glycemic control in patients with diabetes. Exp Clin Endocrinol Diabetes 2012; 120: 560-563
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Gonzalez JS, Peyrot M, McCarl LA et al. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care 2008; 31: 2398-2403
    CrossrefPubMedGoogle Scholar
  • 9 Vogelzangs N, Kritchevsky SB, Beekman AT et al. Depressive symptoms and change in abdominal obesity in older persons. Arch Gen Psychiatry 2008; 65: 1386-1393
    CrossrefPubMedGoogle Scholar
  • 10 Kolb H, Mandrup-Poulsen T. The global diabetes epidemic as a consequence of lifestyle-induced low-grade inflammation. Diabetologia 2010; 53: 10-20
    CrossrefPubMedGoogle Scholar
  • 11 Burtscher M, Gatterer H, Dünnwald T et al. Effects of supervised exercise on gamma-glutamyl transferase levels in patients with isolated impaired fasting glucose and those with impaired fasting glucose plus impaired glucose tolerance. Exp Clin Endocrinol Diabetes 2012; 120: 445-450
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Kemmer FW, Bisping R, Steingrüber HJ et al. Psychological stress and metabolic control in patients with type 1 diabetes mellitus. N Engl J Med 1986; 314: 1078-1084
    CrossrefPubMedGoogle Scholar
  • 13 Bruce DG, Chisholm DJ, Storlien LH et al. The effects of sympathetic nervous system activation and psychological stress on glucose metabolism and blood pressure in subjects with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 1992; 35: 835-843
    CrossrefPubMedGoogle Scholar
  • 14 Goetsch VL, VanDorsten B, Pbert LA et al. Acute effects of laboratory stress on blood glucose in noninsulin-dependent diabetes. Psychosom Med 1993; 55: 492-496
    CrossrefPubMedGoogle Scholar
  • 15 Moberg E, Kollind M, Lins PE et al. Acute mental stress impairs insulin sensitivity in IDDM patients. Diabetologia 1994; 37: 247-251
    CrossrefPubMedGoogle Scholar
  • 16 Kirschbaum C, Gonzalez-Bono E, Rohleder N et al. Effects of fasting and glucose load on free cortisol response to stress and nicotine. J Clin Endocrinol Metab 1997; 82: 1101-1105
    CrossrefPubMedGoogle Scholar
  • 17 Gonzalez-Bono E, Rohleder N, Hellhammer DH et al. Glucose but not protein or fat load amplifies the cortisol response to psychosocial stress. Horm Behav 2002; 41: 328-333
    CrossrefPubMedGoogle Scholar
  • 18 Wiesli P, Schmid C, Kerwer O et al. Acute psychological stress affects glucose concentrations in patients with type 1 diabetes following food intake but not in the fasting state. Diabetes Care 2005; 28: 1910-1915
    CrossrefPubMedGoogle Scholar
  • 19 Faulenbach M, Uthoff H, Schwegler K et al. Effect of psychological stress on glucose control in patients with type 2 diabetes. Diabet Med 2012; 29: 128-131
    CrossrefPubMedGoogle Scholar
  • 20 Cox DJ, Singh H, Clarke WL et al. Metabolic demand of driving among adults with type 1 diabetes mellitus (T1DM). Ann Adv Automot Med 2010; 54: 367-372
    PubMedGoogle Scholar
  • 21 Nowotny B, Cavka M, Herder C et al. Effects of Acute Psychological Stress on Glucose Metabolism and Subclinical Inflammation in Patients with Post-traumatic Stress Disorder. Horm Metab Res 2010; 42: 746-753
    Article in Thieme ConnectPubMedGoogle Scholar