The Ohio State University College of Medicine, Columbus, OH, United States.
Department of Internal Medicine and Pediatrics, University of Pennsylvania, Philadelphia, PA, United States.
Psychoneuroendocrinology. 2021 Jan;123:105041. doi: 10.1016/j.psyneuen.2020.105041. Epub 2020 Nov 4.
A flatter diurnal cortisol curve has been associated with incident diabetes among older white adults. However, this relationship has not been examined among middle-aged individuals or African Americans [AA]. We analyzed the longitudinal association of baseline diurnal cortisol curve features with incident diabetes over a 10 year period in a cohort of AA and white participants who were, on average, 40 years old.
Salivary cortisol was collected immediately post-awakening, then subsequently 45 min, 2.5 h, 8 h, and 12 h later, as well as at bedtime. Cortisol curve features included wake-up cortisol; cortisol awakening response (CAR); early, late, and overall decline slopes; bedtime cortisol; and 16 -h area under the curve (AUC). Salivary cortisol (nmol/L) was log-transformed due to positively skewed distributions. Diabetes was defined as fasting plasma glucose ≥ 126 mg/dL or taking diabetes medication. Logistic regression models were used to investigate the association of log-transformed cortisol curve features with incident diabetes. The analysis was stratified by race and adjusted for age, sex, education, depressive symptoms, smoking status, beta-blocker and steroid medication use and BMI.
Among 376 AA and 333 white participants (mean age 40 years), 67 incident diabetes cases occurred over 10 years. After full adjustment for additional covariates, a 1-unit log increase in CAR was associated with a 53 % lower odds of incident diabetes among whites (Odds Ratio [OR] 0.47, 95 % CI: 0.24, 0.90). A 1-SD increase in late decline slope was associated with a 416 % higher odds of incident diabetes among whites (OR 5.16, 95 % CI: 1.32, 20.20). There were no significant associations in AAs.
A robust CAR and flatter late decline slope are associated with lower and higher odds of incident diabetes, respectively, among younger to middle-aged whites and may provide a future target for diabetes prevention in this population.
在老年白种成年人中，较为平坦的日间皮质醇曲线与新发糖尿病有关。然而，这一关系尚未在中年个体或非裔美国人（AA）中得到检验。我们分析了在一个 AA 和白人参与者队列中，基线日间皮质醇曲线特征与 10 年内新发糖尿病的纵向关联，这些参与者的平均年龄为 40 岁。
在醒来后立即采集唾液皮质醇，然后在 45 分钟、2.5 小时、8 小时和 12 小时以及睡前采集。皮质醇曲线特征包括觉醒皮质醇；皮质醇觉醒反应（CAR）；早期、晚期和总体下降斜率；睡前皮质醇；以及 16 小时 AUC。由于皮质醇分布呈正偏态，因此对唾液皮质醇（nmol/L）进行了对数转换。糖尿病的定义为空腹血糖≥126mg/dL 或服用糖尿病药物。使用逻辑回归模型研究了对数转换的皮质醇曲线特征与新发糖尿病的关联。分析按种族分层，并根据年龄、性别、教育程度、抑郁症状、吸烟状况、β-受体阻滞剂和类固醇药物使用以及 BMI 进行了调整。
在 376 名 AA 和 333 名白人参与者（平均年龄 40 岁）中，10 年内发生了 67 例新发糖尿病。在充分调整了其他协变量后，白人中 CAR 的对数增加 1 个单位与新发糖尿病的几率降低 53%相关（比值比 [OR] 0.47，95%置信区间：0.24，0.90）。晚期下降斜率的 1-SD 增加与白人中新发糖尿病的几率增加 416%相关（OR 5.16，95%置信区间：1.32，20.20）。在 AA 中没有发现显著关联。
在年轻到中年的白人中，较强的 CAR 和较平坦的晚期下降斜率分别与新发糖尿病的几率降低和升高相关，这可能为该人群的糖尿病预防提供了未来的目标。
