Truninger R, Uthoff H, Capraro J, Frauchiger B, Spinas G A, Wiesli P
Department of Internal Medicine, Kantonsspital Frauenfeld, Frauenfeld, Switzerland.
Exp Clin Endocrinol Diabetes. 2013 Jul;121(7):420-4. doi: 10.1055/s-0033-1347246. Epub 2013 Jun 13.
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.
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.
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.
Although a 2 h-driving training causes increased subjective and objective stress parameters, glucose control is maintained in patients with insulin-treated diabetes.
通过驾驶训练研究长期急性精神应激对1型和2型糖尿病患者血糖控制的影响。
39例接受胰岛素治疗的糖尿病患者（18例1型糖尿病，21例2型糖尿病）通过2小时的驾驶训练暴露于精神应激中。训练在摄入标准餐后15分钟开始。定期监测血糖、血压、心率、唾液皮质醇和主观应激感受，并与对照日进行比较。
在应激测试日，血压从142/86±16/9 mmHg升至162/95±22/11 mmHg（p<0.001），心率从72±11次/分钟升至86±16次/分钟（p<0.001），主观应激感受从1.4±0.6分升至4.7±2.5分（p<0.001）。唾液皮质醇浓度从基线时的中位数5.1 nmol/l（四分位间距（IQR）3.5 - 7.5 nmol/l）增至7.7 nmol/l（IQR 4.7 - 12.8 nmol/l，p<0.001），所有这些测量值在对照日保持稳定。与对照日相比，应激测试日的血糖控制无显著差异（随时间的平均差异 = 0.22 mmol/l，95%可信区间 -1.5至 +1.9 mmol/l，p = 0.794）。多变量线性回归和相关性分析显示，人口统计学特征（糖尿病类型、年龄、体重指数（BMI）、糖尿病病程、糖化血红蛋白（HbA1c））、客观或主观应激参数与驾驶训练期间血糖浓度的变化过程无关联。
尽管2小时的驾驶训练会导致主观和客观应激参数增加，但接受胰岛素治疗的糖尿病患者的血糖控制仍能维持。
