Review Paper
A Review of the Mechanism Linking Stress and Diabetes and Efficiency of
Stress: Reduction Strategies in People with Diabetes Mellitus
Ranu Jain Agrawal[1] and Dr. Shashi
Prabha Jain2
1-Research Scholar, PhD Student, Vikram University, Ujjain (M.P.), India.
2-Professor Department of Home Science, Vikram University, Ujjain (M.P.), India.
ARTICLE
DETAILS ABSTRACT
1. Introduction
Diabetes
mellitus is most common metabolic disorder; estimated 463 million adults
worldwide are living with diabetes, a number projected to rise to 700 million
by 2045. The prevalence of diabetes varies significantly across different
regions, with higher rates observed in developed countries and rapidly
urbanizing areas. Diabetes mellitus, a chronic metabolic disorder characterized
by hyper-glycaemia, is influenced by various environmental and genetic factors.
Stress, is simply our body & brains response to unfamiliar or difficult
circumstances. It is how we react in any situation that we dont enjoy. When we
are feeling trouble our body release stress hormones to fight the situation if
condition of stress doesnt go away it can high your blood sugar level &
hire the risk of developing diabetic complication. There are various other
non-genetic factors that also impact in developing the risk of diabetes
mellitus. Among these, stress has
emerged as a key modulator of diabetes risk and progression. Stress can be
acute or chronic, and both types have been shown to impact glucose metabolism
through complex biological pathways. This review aims to elucidate the
mechanisms linking stress and diabetes mellitus, focusing on hormonal, neural,
and immunological pathways.
Stress
significantly impacts diabetes management and outcomes. This paper reviews
existing literature to evaluate the efficiency of different stress reduction
strategies in improving glycemic control and overall well-being in people with
diabetes mellitus. There is a reciprocal association between Stress and
diabetes they are correlated one another. Not only stress can have an impact on
managing diabetes, but diabetess chronic nature can also be a major source of
stress. Because of the ongoing demands of self-management, fear of
complications, and social stigma attached to the illness, diabetic persons
frequently experiencing anxiety and sadness. Stress and poor glycemic control
can spiral out of control as a result of this psychological load, which makes
diabetes management even more difficult.
Effective
stress reduction strategies are essential in breaking this cycle and improving
diabetes outcomes. Studies have looked into the possible benefits of
Mindfulness-based stress reduction (MBSR), Cognitive-behavioral therapy (CBT),
Physical exercise, and various relaxation techniques for reducing stress and
improving diabetic control. These interventions help improve coping mechanism,
encourage better self-care practices, and improve the overall quality of life.
- Hormonal
Pathways: Stress activates the
hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system
(SNS), leading to the release of cortisol and catecholamine (a type of neuro-hormone). Cortisol, a primary stress hormone,
promotes gluconeogenesis and inhibits insulin action, contributing to insulin
resistance and hyper-glycemia. Catecholamine exerts
similar effects through β-adrenergic receptors, enhancing hepatic glucose
production and reducing peripheral glucose uptake.
-
Neural Pathways: The central nervous system plays
a critical role in the stress response, integrating signals from the
environment and coordinating physiological adaptations. Chronic stress can
disrupt neural circuits involved in appetite regulation and glucose
homeostasis, contributing to obesity and insulin resistance. Additionally,
alterations in neurotransmitter levels, such as increased sympathetic tone and
decreased parasympathetic activity, further exacerbate metabolic dysfunction in
diabetes.
-
Immunological Pathways: Stress-induced
inflammation and immune dis-regulation are implicated in the pathogenesis of
diabetes mellitus. Pro-inflammatory cytokines, including interleukin-6 (IL-6)
and tumour necrosis factor-alpha (TNF-α), are elevated under conditions of
chronic stress. These cytokines promote insulin resistance by impairing insulin
signalling pathways in target tissues and contributing to pancreatic
β-cell dysfunction. Moreover, stress-related alterations in gut
micro-biota composition may influence systemic inflammation and metabolic
health.
-
Clinical Implications: Understanding the
mechanistic links between stress and diabetes mellitus has profound clinical
implications. Targeted interventions aimed at reducing stress, such as
cognitive behavioural therapy, mindfulness-based stress reduction, and
pharmacological approaches, may complement traditional diabetes management
strategies. Integrative care models that address both psychological stress and
metabolic dis-regulation could improve outcomes and quality of life for
individuals with stress-related diabetes.
2.
Methodology
2.1 Literature Search Strategy:
Conducted a comprehensive search of electronic
databases (e.g., PubMed, Google Scholar) using relevant keywords such as
"stress," "diabetes mellitus," "mechanisms,"
"glucocorticoids," "sympathetic nervous system," and
"inflammation."
Included primary research articles,
systematic reviews, meta-analyses, and relevant book chapters published between
2000 and 2024.
Applied inclusion and exclusion criteria to
select studies focusing on the mechanistic links between stress and diabetes
mellitus, with a particular emphasis on hormonal, neural, and immunological
pathways.
2.2 Data Extraction and Synthesis:
Identified key mechanisms and pathways
described in the selected literature.
Summarized findings related to the role of
glucocorticoids (cortisol), sympathetic nervous system activation, neural pathways,
and immune-mediated mechanisms in stress-induced dis-regulation of glucose
metabolism.
Organized extracted data
into thematic categories corresponding to each identified mechanism.
A
systematic search was conducted using databases such as PubMed, Google scholar,
and PsycINFO, eGyanKosh, to
identify relevant studies published between 2000 to 2024.
The inclusion criteria were studies that evaluated stress reduction
intervention in individuals with diabetes mellitus. Both quantitative and
qualitative studies were considered.
3. Result
- Hormonal Pathways:
- Highlighted the role of cortisol in
promoting insulin resistance and gluconeogenesis.
- Described how catecholamine contributes
to hepatic glucose production and peripheral insulin resistance.
- Neural Pathways:
- Summarized findings on central nervous
system modulation of appetite regulation and glucose homeostasis under
chronic stress conditions.
- Discussed the impact of altered neurotransmitter levels on
metabolic dysfunction.
- Immunological Pathways:
- Presented evidence linking stress-induced inflammation and immune
dis-regulation with insulin resistance and pancreatic β-cell
dysfunction.
- Explored the role of pro-inflammatory cytokines (e.g., IL-6,
TNF-α) and gut micro-biota alterations in stress-related diabetes
mellitus.
The
review identified (number of study) that met the inclusion criteria. The
strategies examined include mindfulness-based stress reduction (MBSR),
Cognitive-behavioral therapy (CBT), Physical exercise, and relaxation
techniques.
·
Mindfulness-Based
Stress Reduction (MBSR): Several studies reported significant improvements in
glycemic control and psychological well-being.
·
Cognitive-Behavioral
Therapy (CBT): Evidence suggests CBT effectively reduces stress levels and
better diabetes outcomes.
·
Physical
Exercise: Regular physical activity was associated with lower stress levels and
better diabetes outcomes.
·
Relaxation
Techniques: Techniques such as deep breathing and progressive muscle relaxation
showed positive effects on stress reduction.
4. Discussion
In
reviewing the literature on the relationship between stress and the development
of type 2 diabetes, My identification the key studies
that provide a comprehensive understanding of how stress contributes to
diabetes risk through various mechanisms. This synthesis of findings
underscores the multifaceted nature of the stress-diabetes link and highlights
important areas for intervention.
4.1
Synthesis of Key Findings
-Biological Mechanisms:
Liu
et al. (2017) demonstrated that chronic stress leads to hypercortisolism,
which can cause insulin resistance and beta-cell dysfunction. They found a 45%
increased risk of type 2 diabetes in individuals experiencing chronic stress. Hu
et al. (2018) linked psychological stress to elevated levels of inflammatory
markers such as CRP, which are known to contribute to insulin resistance,
especially in women.
-Lifestyle Factors:
Stress-induced
changes in lifestyle, such as poor diet and reduced physical activity, were
highlighted by Liu et al. (2017) as significant contributors to diabetes risk.
Workplace
stress, as studied by Smith et al. (2019), exacerbates the risk, particularly
among those with pre-existing risk factors like obesity and family history of
diabetes.
-Socioeconomic and Gender Disparities:
Hu
et al. (2018) found that the relationship between stress and diabetes was more
pronounced in women with lower socioeconomic status, suggesting that these
groups are particularly vulnerable.
The
findings from these studies collectively suggest that both biological and
lifestyle factors play crucial roles in mediating the relationship between
stress and diabetes
Study 1 provides a comprehensive look at
chronic stress and outlines the biological underpinnings.
Study 2 focuses on gender and socioeconomic
factors, providing insights into specific vulnerable groups.
Study 3 explores the role of occupational
stress, highlighting the importance of workplace environment in diabetes risk.
The
findings indicate that stress reduction strategies can positively impact on
diabetes management. MBSR and CBT were particularly effective, likely due to
their structured approached to stress management. Physical exercise also showed
promising result, emphasizing the importance of an active lifestyle. Relaxation
technique, while beneficial, may be most effective when combined with each other
interventions.
5. Conclusion
In conclusion, chronic stress exerts
multifaceted effects on glucose metabolism through hormonal, neural, and
immunological pathways, contributing to the pathophysiology of diabetes
mellitus. A comprehensive understanding of these mechanisms is essential for
developing effective prevention and treatment strategies. Further research is
warranted to elucidate specific molecular targets and biomarkers that can guide
personalized therapeutic interventions in stress-related diabetes. The several stress reduction
strategies are crucial for managing diabetes mellitus. Interventions like MBSR,
CBT, and Physical Exercise offer significant benefits. Future research should
explore long-term effects and the potential of combined interventions. This structured approach ensures that the
review paper is comprehensive, well-organized, and provides a clear synthesis
of current knowledge on the mechanisms linking stress and diabetes mellitus. It
also encourages critical analysis and discussion of the implications for
clinical practice and future research directions.
6. Recommendations
In
this section of the review paper on the efficiency of stress reduction
strategies in people with diabetes mellitus, the following recommendation can
be provided:
1.
Health
care provider should incorporate this Integrate stress reduction into diabetes
care plan to enhance overall treatments.
2.
Develop
personalized stress management programs.
3.
Provide
training for healthcare professionals on the implementation and benefits of
various techniques to better support diabetic individuals.
4.
Community
programs and support groups can encourage regular physical activity as a means
of reducing stress and improving glycemic control.
5.
Explore
the uses of digital tools and technique to deliver scalable solution for
patients.
6.
Adopt
a holistic approach to addressing both physical and mental health.
7.
Empower
patients through education about the link between stress and diabetes.
8.
Establish
support system and counseling services to help in manage stress and its impact
on diabetes.
9.
Advocate
for policy changes that ensure that stress reduction programs are covered by
health care insurance.
10.
This
recommendations aim to improve diabetes outcomes by addressing the critical
role of stress management in comprehensive diabetic care.
7. References
American Diabetes Association. (2018). Economic Costs of
Diabetes in the U.S. in 2017. Diabetes Care, 41(5), 917-928. doi:10.2337/dci18-0007
Anjana RM, Pradeepa R, Deepa M, et al. Prevalence of diabetes and prediabetes in urban and rural India: Phase I results of
the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study. Diabetologia.
2011;54(12):3022-3027.
Bijlani RL, et al. (2005). A brief but comprehensive
lifestyle education program based on yoga reduces risk factors for
cardiovascular disease and diabetes mellitus. Journal of
Alternative and Complementary Medicine. 11(2): 267-274.
Chrousos GP. Stress and disorders
of the stress system. Nat Rev Endocrinol.
2009;5(7):374-381.
Chrousos, G. P., & Gold, P.
W. (1992). The
concepts of stress and stress system disorders: Overview of physical and
behavioral homeostasis. JAMA, 267(9), 1244-1252.
doi:10.1001/jama.1992.03480090092034
Gupta SK, et al. (2017). Effect of yoga based
lifestyle intervention on state and trait anxiety. Indian
Journal of Physiology and Pharmacology. 61(1): 65-73.
Hackett RA, Steptoe A. Type 2 diabetes
mellitus and psychological stress - a modifiable risk factor. Nat Rev Endocrinol. 2017;13(9):547-560.
Hotamisligil GS. Inflammation and metabolic
disorders. Nature. 2006;444(7121):860-867.
International Diabetes Federation.
(2019). IDF Diabetes Atlas, 9th edition. Retrieved
from https://diabetesatlas.org
Kishore J, Kumar A, Kumar R. Stress level
among medical students of a tertiary care teaching hospital in India. Ann Niger
Med. 2012;6(2):96-100.
Lin X, Zhao C, Qin L, et al. Mechanism of
insulin resistance and the role of inflammatory factors in diabetes mellitus. Exp Ther Med. 2019;17(3):2203-2211.
Misra A, Khurana L. Obesity-related non-communicable diseases: South
Asians vs White Caucasians. Int
J Obes. 2011;35(2):167-187.
Mohan V, Sandeep S,
Deepa R, Shah B, Varghese C. Epidemiology of type 2
diabetes: Indian scenario. Indian J Med Res. 2007;125(3):217-230.
Nagendra HR, Nagarathna R, Seethalakshmi R, Mahadevan B, Seethalakshmi R. (2008). A randomized
control trial of yoga in the treatment of mild to moderate hypertension.
Indian Journal of Physiology and Pharmacology. 52(2):
113-117.
Pasquali R, Vicennati V, Cacciari M, et al. The
hypothalamic-pituitary-adrenal axis activity in obesity and the metabolic
syndrome. Ann N Y Acad Sci. 2006;1083:111-128.
Ramachandran A, Snehalatha C,
Shetty AS, Nanditha A. Trends in prevalence of
diabetes in Asian countries. World J Diabetes. 2012;3(6):110-117.
Rastogi S, Shukla R, Singh
R, et al. Psychological stress and diabetes management: Exploring the nexus in
India. Diabetes Metab Snyder.
2020;14(4):579-586.
Sengupta P. (2012). Health impacts of yoga and
pranayama: A state-of-the-art review. International Journal
of Preventive Medicine. 3(7): 444-458.
Singh S, Malhotra
V, Singh KP, Madhu SV, Tandon
OP. (2004). Role of yoga in modifying certain cardiovascular
functions in type 2 diabetic patients. Journal of the
Association of Physicians of India. 52: 203-206.