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

BMC Endocrine Disorders

Hans O Thulesius¹  Magnus Hillman⁴  Mona Landin-Olsson³  Maria Thunander⁵  Eva O Melin² 

[1] Department of Clinical Sciences, Family Medicine, Lund University, Malmö, Sweden;Box 1223, 351 12 Växjö, Sweden;Department of Internal Medicine, Lund University Hospital, Lund, Sweden;Department of Clinical Sciences, Endocrinology and Diabetes, Lund University, Lund, Sweden;Department of Internal Medicine, Central Hospital, Kronoberg County Council, Växjö, Sweden

关键词: HbA1c;    Season;    Physical activity;    Smoking;    Type 1 diabetes;    Depression;    Midnight salivary cortisol;   

Others  :  1084999
DOI  :  10.1186/1472-6823-14-75

 received in 2014-05-19, accepted in 2014-09-05,  发布年份 2014

【 摘 要 】

Background

Disturbances 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.

Methods

A 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.

Results

Thirty 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).

Conclusions

In 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.

【 授权许可】

   
2014 Melin et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Anderson R, Freedland K, Clouse R, Lustman P: The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001, 24:1069-1078.
• [2]Korczak DJ, Pereira S, Koulajian K, Matejcek A, Giacca A: Type 1 diabetes mellitus and major depressive disorder: evidence for a biological link. Diabetologia 2011, 54:2483-2493.
• [3]Gold PW, Chrousos GP: Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states. Mol Psychiatry 2002, 7:254-275.
• [4]Melin EO, Thunander M, Svensson R, Landin-Olsson M, Thulesius HO: Depression, obesity and smoking were independently associated with inadequate glycemic control in patients with type 1 diabetes. Eur J Endocrinol 2013, 168:861-869.
• [5]Egede LE, Nietert PJ, Zheng D: Depression and all-cause and coronary heart disease mortality among adults with and without diabetes. Diabetes Care 2005, 28:1339-1345.
• [6]Gillespie CF, Nemeroff CB: Hypercortisolemia and depression. Psychosom Med 2005, 67(Suppl 1):26-28.
• [7]Feelders RA, Pulgar SJ, Kempel A, Pereira AM: The burden of Cushing’s disease: clinical and health-related quality of life aspects. Eur J Endocrinol 2012, 167:311-326.
• [8]Alwani RA, Schmit Jongbloed LW, de Jong FH, van der Lely AJ, de Herder WW, Feelders RA: Differentiating between Cushing’s disease and pseudo-Cushing’s syndrome: comparison of four tests. Eur J Endocrinol 2014, 170:477-486.
• [9]Reynolds RM, Strachan MWJ, Labad J, Lee AJ, Frier BM, Fowkes FG, Mitchell R, Seckl JR, Deary IJ, Walker BR, Price JF, Investigators obotETDS: Morning cortisol levels and cognitive abilities in people with type 2 diabetes: the Edinburgh type 2 diabetes study. Diabetes Care 2010, 33:714-720.
• [10]Dekker MJ, Koper JW, van Aken MO, Pols HAP, Hofman A, de Jong FH, Kirschbaum C, Witteman JCM, Lamberts SWJ, Tiemeier H: Salivary cortisol is related to atherosclerosis of carotid arteries. J Clin Endocrinol Metab 2008, 93:3741-3747.
• [11]Reynolds RM, Labad J, Strachan MWJ, Braun A, Fowkes FGR, Lee AJ, Frier BM, Seckl JR, Walker BR, Price JF, Investigators obotETDS: Elevated fasting plasma cortisol is associated with ischemic heart disease and its risk factors in people with type 2 diabetes: the Edinburgh type 2 diabetes study. J Clin Endocrinol Metab 2010, 95:1602-1608.
• [12]Knight JM, Avery EF, Janssen I, Powell LH: Cortisol and depressive symptoms in a population-based cohort of midlife women. Psychosom Med 2010, 72:855-861.
• [13]Matthews K, Schwartz J, Cohen S, Seeman T: Diurnal cortisol decline is related to coronary calcification: CARDIA study. Psychosom Med 2006, 68:657-661.
• [14]Kumari M, Shipley M, Stafford M, Kivimaki M: Association of diurnal patterns in salivary cortisol with all-cause and cardiovascular mortality: findings from the Whitehall II study. J Clin Endocrinol Metab 2011, 96:1478-1485.
• [15]Persson R, Garde AH, Hansen AM, Osterberg K, Larsson B, Orbaek P, Karlson B: Seasonal variation in human salivary cortisol concentration. Chronobiol Int 2008, 25:923-937.
• [16]Cahill S, Tuplin E, Holahan MR: Circannual changes in stress and feeding hormones and their effect on food-seeking behaviors. Front Neurosci 2013, 7:140.
• [17]Thorn L, Evans P, Cannon A, Hucklebridge F, Clow A: Seasonal differences in the diurnal pattern of cortisol secretion in healthy participants and those with self-assessed seasonal affective disorder. Psychoneuroendocrinology 2011, 36:816-823.
• [18]Postolache TT, Mortensen PB, Tonelli LH, Jiao X, Frangakis C, Soriano JJ, Qin P: Seasonal spring peaks of suicide in victims with and without prior history of hospitalization for mood disorders. J Affect Disord 2010, 121:88-93.
• [19]Boyce P, Barriball E: Circadian rhythms and depression. Aust Fam Physician 2010, 39:307-310.
• [20]Scheer F, Buijs R: Light affects morning salivary cortisol in humans. J Clin Endocrinol Metab 1999, 84:3395-3398.
• [21]Larsson CA, Gullberg B, Rastam L, Lindblad U: Salivary cortisol differs with age and sex and shows inverse associations with WHR in Swedish women: a cross-sectional study. BMC Endocr Disord 2009, 9:16. BioMed Central Full Text
• [22]Badrick E, Kirschbaum C, Kumari M: The relationship between smoking status and cortisol secretion. J Clin Endocrinol Metab 2007, 92:819-824.
• [23]Berlin I, Covey LS, Glassman AH: Smoking and depression: a co-morbidity. J Dual Diagn 2009, 5:149-158.
• [24]Dunn AL, Trivedi MH, Kampert JB, Clark CG, Chambliss HO: Exercise treatment for depression: efficacy and dose response. Am J Prev Med 2005, 28:1-8.
• [25]Hoffman BM, Babyak MA, Craighead WE, Sherwood A, Doraiswamy PM, Coons MJ, Blumenthal JA: Exercise and pharmacotherapy in patients with major depression: one-year follow-up of the SMILE study. Psychosom Med 2011, 73:127-133.
• [26]Traustadottir T, Bosch PR, Matt KS: The HPA axis response to stress in women: effects of aging and fitness. Psychoneuroendocrinology 2005, 30:392-402.
• [27]Manthey L, Leeds C, Giltay EJ, van Veen T, Vreeburg SA, Penninx BWJH, Zitman FG: Antidepressant use and salivary cortisol in depressive and anxiety disorders. Eur Neuropsychopharmacol 2011, 21:691-699.
• [28]Putignano P, Toja P, Dubini A, Pecori Giraldi F, Corsello SM, Cavagnini F: Midnight salivary cortisol versus urinary free and midnight serum cortisol as screening tests for Cushing’s syndrome. J Clin Endocrinol Metab 2003, 88:4153-4157.
• [29]Yaneva M, Kirilov G, Zacharieva S: Midnight salivary cortisol, measured by highly sensitive electrochemiluminescence immunoassay, for the diagnosis of Cushing’s syndrome. Cent Eur J Med 2009, 4:59-64.
• [30]Vogeser M, Durner J, Seliger E, Auernhammer C: Measurement of late-night salivary cortisol with an automated immunoassay system. Clin Chem Lab Med 2006, 44:1441-1445.
• [31]Belaya ZE, Iljin AV, Melnichenko GA, Rozhinskaya LY, Dragunova NV, Dzeranova LK, Butrova SA, Troshina EA, Dedov II: Diagnostic performance of late-night salivary cortisol measured by automated electrochemiluminescence immunoassay in obese and overweight patients referred to exclude Cushing's syndrome. Endocrine 2012, 41:494-500.
• [32]Deutschbein T, Broecker-Preuss M, Flitsch J, Jaeger A, Althoff R, Walz MK, Mann K, Petersenn S: Salivary cortisol as a diagnostic tool for Cushing's syndrome and adrenal insufficiency: improved screening by an automatic immunoassay. Eur J Endocrinol 2012, 166:613-618.
• [33]Putignano P, Dubini A, Toja P, Invitti C, Bonfanti S, Redaelli G, Zappulli D, Cavagnini F: Salivary cortisol measurement in normal-weight, obese and anorexic women: comparison with plasma cortisol. Eur J Endocrinol 2001, 145:165-171.
• [34]Melin EO, Thulesius HO, Persson BA: Affect School for chronic benign pain patients showed improved alexithymia assessments with TAS-20. Biopsychosoc 2010, 4:1-10. BioMed Central Full Text
• [35]Mehling WE, Wrubel J, Daubenmier J, Price CJ, Kerr CE, Silow T, Gopisetty V, Stewart AL: Body awareness: a phenomenological inquiry into the common ground of mind-body therapies. Philos Ethics Humanit Med 2011, 6:1-6. BioMed Central Full Text
• [36]Lisspers J, Nygren A, Soderman E: Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample. Acta Psychiatr Scand 1997, 96:281-286.
• [37]Lavalard E, Szymezak J, Leroy N, Gillery P: Evaluation of variant II analyzer equipped with the new 270-2101 NU kit (Bio-Rad) for HbA 1c assay. Ann Biol Clin 2009, 67:55-65.
• [38]Hoelzel W, Weykamp C, Jeppsson JO, Miedema K, Barr JR, Goodall I, Hoshino T, John WG, Kobold U, Little R, Mosca A, Mauri P, Paroni R, Susanto F, Takei I, Thienpont L, Umemoto M, Wiedmeyer HM: IFCC reference system for measurement of hemoglobin A1c in human blood and the national standardization schemes in the United States, Japan, and Sweden: a method-comparison study. Clin Chem 2004, 50:166-174.