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Diabetes-related distress and daily cortisol output in people with Type 2 diabetes

Research output: Contribution to journalArticle

Hetashi Bawa, Lydia Poole, Debbie Cooke, Laura Panagi, Andrew Steptoe, Ruth A Hackett

Original languageEnglish
Article number108472
Pages (from-to)108472
JournalDiabetes Research and Clinical Practice
Early online date28 Sep 2020
E-pub ahead of print28 Sep 2020
PublishedNov 2020

Bibliographical note

Copyright © 2020 Elsevier B.V. All rights reserved.

King's Authors


AIMS: Diabetes-related distress is common in Type 2 Diabetes and is linked with poor diabetes control. However, mechanisms underlying this association are unclear. One pathway that could be involved is neuroendocrine dysfunction, as Type 2 Diabetes is associated with altered diurnal cortisol output. This study investigated the link between diabetes-related distress and diurnal cortisol output.

METHODS: 134 people with Type 2 Diabetes provided 5 cortisol samples over the course of a day. Multivariate linear regression models were used to assess whether overall and sub-domains of diabetes-related distress measured by the Diabetes Distress Scale, predicted cortisol parameters (waking cortisol, cortisol awakening response, cortisol slope and evening cortisol).

RESULTS: Physician-related distress was associated with greater waking (B = 2.747, p = .015) and evening cortisol (B = 1.375, p = .014), and a blunted cortisol awakening response (B = -3.472, p = .038) adjusting for age, sex, income, body mass index, smoking and time of awakening. No associations were detected for overall distress, emotional, interpersonal or regimen distress.

CONCLUSION: Physician-related distress was associated with alterations in daily cortisol output. Longitudinal research is required to understand how physician-related distress is associated with diurnal cortisol patterning over time.

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