Hackett Ruth A, Kivimäki Mika, Kumari Meena, Steptoe Andrew
Department of Epidemiology and Public Health (R.A.H., M.Ki., A.S.), University College London, London, WC1E 6BT, UK; Institute for Social and Economic Research (M.Ku.), University of Essex, Colchester, Essex, CO4 3SQ, UK.
J Clin Endocrinol Metab. 2016 Feb;101(2):619-25. doi: 10.1210/jc.2015-2853. Epub 2015 Dec 8.
The hypothalamic pituitary-adrenal axis is thought to play a role in type 2 diabetes (T2D). However, evidence for an association between cortisol and future glucose disturbance is sparse.
The aim was to examine the association of diurnal cortisol secretion with future T2D and impaired glucose metabolism in a community-dwelling population.
This is a prospective cohort study of salivary cortisol measured at the 2002-2004 clinical examination of the Whitehall II study, United Kingdom. We measured cortisol (nmol/l) from six saliva samples obtained over the course of a day: at waking, +30 minutes, +2.5 hours, +8 hours, +12 hours, and bedtime. Participants who were normoglycemic in 2002-2004 (phase 7) were reexamined in 2012-2013 (phase 11).
The occupational cohort was originally recruited in 1985-1988.
A total of 3270 men and women with an average age of 60.85 years at phase 7 (2002-2004).
Incident T2D and impaired fasting glucose in 2012-2013 were measured.
Raised evening cortisol at phase 7 was predictive of new-onset T2D at phase 11 (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.01-1.37) with a trend for a flatter slope in participants with incident T2D (odds ratio, 1.15; 95% CI, 0.99-1.33). When expanding this analysis to a broader category of glucose disturbance we found that a flattened diurnal cortisol slope at phase 7 was predictive of future impaired fasting glucose or T2D at phase 11 (OR, 1.12; 95% CI, 1.02-1.22), as was high bedtime cortisol (OR, 1.10; 95% CI, 1.01-1.20).
In this nonclinical population, alterations in diurnal cortisol patterns were predictive of future glucose disturbance.
下丘脑 - 垂体 - 肾上腺轴被认为在2型糖尿病（T2D）中起作用。然而，关于皮质醇与未来血糖紊乱之间关联的证据很少。
旨在研究社区居住人群中昼夜皮质醇分泌与未来T2D及糖代谢受损之间的关联。
这是一项前瞻性队列研究，对英国白厅II研究2002 - 2004年临床检查时测量的唾液皮质醇进行研究。我们测量了一天中六个唾液样本中的皮质醇（nmol/l）：醒来时、30分钟后、2.5小时后、8小时后、12小时后和就寝时间。2002 - 2004年（第7阶段）血糖正常的参与者在2012 - 2013年（第11阶段）再次接受检查。
该职业队列最初于1985 - 1988年招募。
第7阶段（2002 - 2004年）共有3270名男性和女性，平均年龄为60.85岁。
测量2012 - 2013年新发的T2D和空腹血糖受损情况。
第7阶段夜间皮质醇升高可预测第11阶段新发T2D（比值比[OR]，1.18；95%置信区间[CI]，1.01 - 1.37），新发T2D参与者的斜率有更平缓的趋势（比值比，1.15；95% CI，0.99 - 1.33）。当将此分析扩展到更广泛的血糖紊乱类别时，我们发现第7阶段昼夜皮质醇斜率变平可预测第11阶段未来空腹血糖受损或T2D（OR，1.12；95% CI，1.02 - 1.22），就寝时皮质醇水平高也有此预测作用（OR，1.10；95% CI，1.01 - 1.20）。
在这个非临床人群中，昼夜皮质醇模式的改变可预测未来的血糖紊乱。
