Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy.
Section of Neurosciences, Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy.
World J Biol Psychiatry. 2022 Mar-Apr;23(4):278-286. doi: 10.1080/15622975.2021.1973280. Epub 2021 Oct 28.
Bipolar disorder (BD) is frequently associated with type 2 diabetes mellitus (T2DM). The functioning of the hypothalamic-pituitary-adrenal (HPA) axis has been never investigated in BD with respect to the glucose metabolic status. Therefore, we assessed the cortisol awakening response (CAR) in bipolar patients with or without comorbid T2DM.
Twenty euglycemic bipolar patients [12 males and eight females; mean age (±): 47.4 ± 14.4 years; mean (±) duration of illness: 18.3 ± 12.1 years], 16 BD patients with T2DM [11 males and five females; mean age (±): 63.6 ± 12.8 years; mean (±) duration of bipolar illness: 17.1 ± 10.8 years; mean (±) duration of T2DM: 5.2 ± 5.3 years], 18 healthy subjects [seven males and 11 females; mean age (±): 45.0 ± 12.1 years] and 12 non-psychiatric subjects with T2DM [eight males and four females; mean age (±): 56.7 ± 11.2 years; mean (±) duration of T2DM: 5.2 ± 3.5 years] were recruited. Saliva cortisol was measured at awakening and after 15, 30, and 60 min.
With respect to both healthy controls and controls with T2DM, euglycemic and diabetic BD patients exhibited a CAR occurring at significantly lower levels. No significant difference emerged in the CAR between the two groups of bipolar patients. Controls with T2DM had an overall post-awakening cortisol production significantly higher than healthy controls.
Our results show that the CAR of patients with BD is reduced in terms of overall cortisol production but normal in terms of cortisol reactivity independently from the occurrence of comorbid T2DM. The dampened CAR points to a tuning down of the functioning of the HPA axis. in both euglycemic and diabetic BD patients, which may be a factor of vulnerability, since a preserved HPA axis functioning is essential to deal with stressors, which may precipitate affective episodes.
双相情感障碍（BD）常与 2 型糖尿病（T2DM）相关。目前，尚未有研究调查 HPA 轴功能与 BD 患者糖代谢状态之间的关系。因此，我们评估了伴或不伴 T2DM 的双相情感障碍患者的皮质醇觉醒反应（CAR）。
共纳入 20 例血糖正常的双相情感障碍患者（12 名男性，8 名女性；平均年龄（±）：47.4±14.4 岁；平均（±）病程：18.3±12.1 年），16 例伴 T2DM 的双相情感障碍患者（11 名男性，5 名女性；平均年龄（±）：63.6±12.8 岁；平均（±）双相情感障碍病程：17.1±10.8 年；平均（±）T2DM 病程：5.2±5.3 年），18 例健康对照者（7 名男性，11 名女性；平均年龄（±）：45.0±12.1 岁）和 12 例非精神科 T2DM 患者（8 名男性，4 名女性；平均年龄（±）：56.7±11.2 岁；平均（±）T2DM 病程：5.2±3.5 年）。分别在觉醒时、15、30 和 60 分钟测量唾液皮质醇。
与健康对照组和 T2DM 对照组相比，血糖正常和糖尿病的 BD 患者的 CAR 明显较低。两组双相情感障碍患者的 CAR 无显著差异。T2DM 对照组的觉醒后皮质醇总生成量明显高于健康对照组。
我们的结果表明，BD 患者的 CAR 在整体皮质醇生成方面减少，但在皮质醇反应性方面正常，与是否发生共患 T2DM 无关。减弱的 CAR 表明 HPA 轴功能失调，这可能是易感性的一个因素，因为 HPA 轴功能的正常维持对于应对压力源至关重要，而压力源可能会引发情感发作。在血糖正常和糖尿病的 BD 患者中，这可能是一个因素，因为 HPA 轴功能的正常维持对于应对压力源至关重要，而压力源可能会引发情感发作。
