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Sun S, Wang Y. Relationship between cortisol and diabetic microvascular complications: a retrospective study. Eur J Med Res 2023; 28:391. [PMID: 37773081 PMCID: PMC10543849 DOI: 10.1186/s40001-023-01325-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 08/27/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE We aimed to investigate whether serum cortisol associate with diabetic microvascular compliments in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS The subjects were recruited from hospitalized patients with T2DM from 2019 to 2021. The odds ratios (OR) and corresponding 95% confidence intervals (CI) in relation to cortisol quartiles were obtained by multiple logistic regression analysis. RESULTS (1) Cortisol level was positively correlated with the severity of microalbuminuria. The OR (95% CI) of microalbuminuria and macroalbuminuria in the last quartile were 3.396 (2.030, 5.682) and 8.407 (3.726, 18.971) compared with the first quartile (p < 0.001). (2) Cortisol level was positively correlated with the severity of diabetic retinopathy (DR). The OR (95% CI) of non-proliferative diabetic retinopathy group (NPDR) and proliferative diabetic retinopathy group (PDR) in the last quartile were 2.007 (1.401, 2.875) and 7.122 (2.525, 20.090) compared with the first quartile. (3) Elevated cortisol level was associated with diabetic peripheral neuropathy. The OR (95% CI) of diabetic peripheral neuropathy (DPN) in the last quartile was 1.956 (1.371, 2.792) and that in the third quartile was 1.854 (1.319, 2.608). CONCLUSIONS High serum cortisol levels were significantly associated with diabetic microvascular compliments in inpatients. Its causality remains to be further studied. CLINICAL TRIAL REGISTRATION NUMBER ChiCTR2100051749.
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Affiliation(s)
- Shengnan Sun
- The Affiliated Hospital of Qingdao University, Qingdao, China
- Tianjin Medical University, Tianjin, 300134, China
| | - Yangang Wang
- The Affiliated Hospital of Qingdao University, Qingdao, China.
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Khan SU, Jannat S, Shaukat H, Unab S, Tanzeela, Akram M, Khan Khattak MN, Soto MV, Khan MF, Ali A, Rizvi SSR. Stress Induced Cortisol Release Depresses The Secretion of Testosterone in Patients With Type 2 Diabetes Mellitus. Clin Med Insights Endocrinol Diabetes 2023; 16:11795514221145841. [PMID: 36636127 PMCID: PMC9830570 DOI: 10.1177/11795514221145841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/29/2022] [Indexed: 01/05/2023] Open
Abstract
Background Both hormonal and genetic data reveal that the stress hormone cortisol and its regulating genes may affect the level of testosterone in humans. It is uncertain whether type 2 diabetes mellitus would manifest similarly. Furthermore, a genetic strategy to screen out the stress system genes that may contribute to testosterone decline in humans is less understood. Objectives In this study, we aimed to elucidate the link between stress and testosterone levels, both hormonally and genetically. Method This study comprised 37 individuals with type 2 diabetes mellitus and 50 healthy individuals. For the analysis of hormones and the targeted genes, we used the RIA system and bioinformatics expertise. Results The patients had significantly elevated cortisol and lower testosterone readings, according to data from hormonal analyses. The bioinformatics approach reveals that SHBG was intracellularly suppressed by 2 defined stress system genes: FKB5 and CYP17. TCF4/TCF8, ATRX, and AR in skeletal muscle were inversely related to stress system genes. Furthermore, all testosterone regulated genes were positively linked with SHBG in the current study. A strong relationship between GNAS and PKA with CYP17 and FKBP5 reveals that the Gαs-cAMP/PKA signaling pathway may be one of the regulatory pathways through which the suppression of testosterone system genes happens. In conclusion, this study demonstrated that beyond stress, the key stress system genes might affect cortisol levels, which in turn affect testosterone figures via the Gαs-cAMP/PKA signaling pathway.
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Affiliation(s)
- Safir Ullah Khan
- Department of Zoology, Wildlife and Fisheries, Pir Mehr Ali Shah Arid Agriculture University Rawalpindi, Rawalpindi, Pakistan
- Departments of Cell Biology Center for Research and Advanced Studies of the IPN, Mexico City, Mexico
- Departments of Biology Autonomous University of Madrid, Madrid, Spain
| | - Saba Jannat
- Department of Zoology, Women University Swabi, Swabi, Pakistan
| | - Hadia Shaukat
- Department of Zoology, Women University Swabi, Swabi, Pakistan
| | - Shiza Unab
- Department of Zoology, University of Mianwali, Mianwali, Pakistan
| | - Tanzeela
- Department of Zoology, Women University Swabi, Swabi, Pakistan
| | - Maleeha Akram
- Department of Zoology, Wildlife and Fisheries, Pir Mehr Ali Shah Arid Agriculture University Rawalpindi, Rawalpindi, Pakistan
| | | | - Monica Vizcara Soto
- Departments of Cell Biology Center for Research and Advanced Studies of the IPN, Mexico City, Mexico
| | | | - Amir Ali
- Nanoscience and Nanotechnology Program, Center for Research and Advanced Studies of the IPN, Mexico City, Mexico
| | - Syed Shakeel Raza Rizvi
- Department of Zoology, Wildlife and Fisheries, Pir Mehr Ali Shah Arid Agriculture University Rawalpindi, Rawalpindi, Pakistan
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Zhang X, Deng X, Zhou J, Qiu K, Deng M, Lin Z, Mosha SS, Li W. The Association Of Serum Cortisol Level With Microalbuminuria In Patients With Type 2 Diabetes And Prediabetes. Int J Med Sci 2020; 17:2998-3004. [PMID: 33173420 PMCID: PMC7646104 DOI: 10.7150/ijms.48742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/07/2020] [Indexed: 01/23/2023] Open
Abstract
Whether cortisol secretion is linked with microalbuminuria remains undefined. We aimed to investigate the relationship between serum cortisol levels and the presence of microalbuminuria in patients with type 2 diabetes (T2DM) and prediabetes. A cross-sectional study was conducted with 211 patients with T2DM or prediabetes. Serum cortisol was measured at 8:00 h, 16:00 h, and 0:00 h. The level and circadian rhythm of ACTH were also evaluated. Urine excretion of albumin was measured. Patients were subdivided into microalbuminuria (MAU) group (n= 120) and normoalbuminuria (NAU) group (n = 91) according to the status of microalbuminuria. Levels of serum cortisol (8:00 h: 426.9 ± 155.0 nmol/; 16:00 h: 303.7 ± 144.7 nmol/L) were significantly higher in MAU group than in NAU group (8:00 h: 370.2 ±130.6 nmol/L, P = 0.004; 16:00 h: 234.7 ± 120.2 nmol/L, P = 0.001). After adjustment for multiple factors, the correlation between cortisol levels (both at 8:00 h (P = 0.005) and at 16:00 h (P = 0.001)) and microalbuminuria remained consistent and significant. Higher levels of cortisol (cut-off value: 390.5 nmol/L at 8:00 h, 203.5 nmol/L at 16:00 h) help to detect the development of microalbuminuria. Serum cortisol secretion is associated with the presence of microalbuminuria in patients with T2DM and patients with prediabetes. Higher levels of cortisol, even in the normal range, may be related with the development of microalbuminuria.
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Affiliation(s)
- Xiaodan Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, 250 East Changgang Road, Haizhu District, Guangzhou, China
| | - Xiaoyi Deng
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, 250 East Changgang Road, Haizhu District, Guangzhou, China
| | - Jianlong Zhou
- The Second Clinical Medicine School, Guangzhou Medical University, Guangzhou, China
| | - Kangshou Qiu
- The Second Clinical Medicine School, Guangzhou Medical University, Guangzhou, China
| | - Mingye Deng
- The Second Clinical Medicine School, Guangzhou Medical University, Guangzhou, China
| | - Zhuohang Lin
- The Second Clinical Medicine School, Guangzhou Medical University, Guangzhou, China
| | - Singla Sethiel Mosha
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, 250 East Changgang Road, Haizhu District, Guangzhou, China
| | - Wangen Li
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, 250 East Changgang Road, Haizhu District, Guangzhou, China
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Ryotokuji K, Ishimaru K, Kihara K, Namiki Y, Hozumi N. Preliminary results of pinpoint plantar long-wavelength infrared light irradiation on blood glucose, insulin and stress hormones in patients with type 2 diabetes mellitus. Laser Ther 2013. [PMID: 24204095 DOI: 10.5978/islsm.13-or-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND AIMS This study was aimed at the development of a novel noninvasive treatment system, "pinpoint plantar long-wavelength infrared light irradiation (PP-LILI)", which may be able to relieve mental stress and normalize blood glucose level via the reduction of stress hormones in type 2 (non-insulin-dependent) diabetes mellitus (DM) patients. MATERIALS (SUBJECTS) AND METHODS Based on this hypothesis, the present study was undertaken to examine effects of PP-LILI on stress hormones (ACTH and cortisol), blood glucose, HbA1c, and insulin levels in 10 patients with type 2 DM. Each patient received PP-LILI of the foot for 15 minutes once weekly using a stress free apparatus (infrared wavelength, 9,000-12,000 nm/power 30 mW). RESULTS In response to this therapy, ACTH (P<0.01) and cortisol (P<0.05) levels decreased significantly. Fasting blood glucose (P<0.05) and insulin (P<0.05) levels also decreased significantly along with a tendency for HbA1c to decrease. CONCLUSIONS The present data raise the possibility that PP-LILI can normalize blood glucose levels by reducing stress hormones such as cortisol, which aggravate DM, and by improving insulin sensitivity, thereby contributing to prevention and treatment of DM.
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Affiliation(s)
- Kenji Ryotokuji
- Faculty of Health Sciences, Ryotokuji University, Urayasu, Japan
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Ryotokuji K, Ishimaru K, Kihara K, Namiki Y, Hozumi N. Preliminary results of pinpoint plantar long-wavelength infrared light irradiation on blood glucose, insulin and stress hormones in patients with type 2 diabetes mellitus. Laser Ther 2013; 22:209-14. [PMID: 24204095 PMCID: PMC3813999 DOI: 10.3136/islsm.22.209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 08/13/2013] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIMS This study was aimed at the development of a novel noninvasive treatment system, "pinpoint plantar long-wavelength infrared light irradiation (PP-LILI)", which may be able to relieve mental stress and normalize blood glucose level via the reduction of stress hormones in type 2 (non-insulin-dependent) diabetes mellitus (DM) patients. MATERIALS (SUBJECTS) AND METHODS Based on this hypothesis, the present study was undertaken to examine effects of PP-LILI on stress hormones (ACTH and cortisol), blood glucose, HbA1c, and insulin levels in 10 patients with type 2 DM. Each patient received PP-LILI of the foot for 15 minutes once weekly using a stress free apparatus (infrared wavelength, 9,000-12,000 nm/power 30 mW). RESULTS In response to this therapy, ACTH (P<0.01) and cortisol (P<0.05) levels decreased significantly. Fasting blood glucose (P<0.05) and insulin (P<0.05) levels also decreased significantly along with a tendency for HbA1c to decrease. CONCLUSIONS The present data raise the possibility that PP-LILI can normalize blood glucose levels by reducing stress hormones such as cortisol, which aggravate DM, and by improving insulin sensitivity, thereby contributing to prevention and treatment of DM.
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Affiliation(s)
- Kenji Ryotokuji
- Faculty of Health Sciences, Ryotokuji University, Urayasu, Japan
| | - Keisou Ishimaru
- Faculty of Health Sciences, Ryotokuji University, Urayasu, Japan
| | - Kazuhiko Kihara
- Faculty of Health Sciences, Ryotokuji University, Urayasu, Japan
| | - Yoshihisa Namiki
- Faculty of Health Sciences, Ryotokuji University, Urayasu, Japan
| | - Nobumichi Hozumi
- Faculty of Health Sciences, Ryotokuji University, Urayasu, Japan
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Parenteral amino acids v. dextrose infusion: an anabolic strategy to minimise the catabolic response to surgery while maintaining normoglycaemia in diabetes mellitus type 2 patients. Br J Nutr 2011; 107:573-80. [DOI: 10.1017/s0007114511003126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Loss of body protein and hyperglycaemia represent typical features of the stress response to surgery and anaesthesia. This appears to be particularly pronounced in patients with diabetes mellitus type 2. The aim of the present study was to highlight the greater benefit of amino acids (AA) as represented by positive protein balance and maintenance of blood glucose homoeostasis compared with dextrose (DEX) in diabetic patients after colorectal surgery. A total of thirteen patients underwent a 5 h stable isotope infusion study (2 h fasted, 3 h fed with an infusion of AA (n 6) or DEX (n 7)) on the second post-operative day. Glucose and protein kinetics were assessed by using the stable isotopes l-[1-13C]leucine and [6,6-2H2]glucose. The transition from fasted to fed state decreased endogenous glucose production (P < 0·001) in both groups, with a more profound effect in the DEX group (P = 0·031). In contrast, total glucose production was increased by the provision of DEX while being lowered by AA (P = 0·021). Feeding decreased protein oxidation (P = 0·009) and protein synthesis in the AA group, whereas DEX infusion did not affect oxidation and even decreased protein synthesis. Therefore, only AA shifted protein balance to a positive value, while patients in the DEX group remained in a catabolic state (P < 0·001). Parenteral nutritional support with AA rather than with DEX is an effective strategy to achieve a positive protein balance while maintaining normoglycaemia in diabetic patients after colorectal surgery.
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Chiodini I, Adda G, Scillitani A, Coletti F, Morelli V, Di Lembo S, Epaminonda P, Masserini B, Beck-Peccoz P, Orsi E, Ambrosi B, Arosio M. Cortisol secretion in patients with type 2 diabetes: relationship with chronic complications. Diabetes Care 2007; 30:83-8. [PMID: 17192338 DOI: 10.2337/dc06-1267] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The presence of an enhanced cortisol secretion in patients with type 2 diabetes is debated. In type 2 diabetic subjects, cortisol secretion was found to be associated with the complications and metabolic control of diabetes. We evaluated cortisol secretion in 170 type 2 diabetic subjects and in 71 sex-, age-, and BMI-matched nondiabetic subjects. RESEARCH DESIGN AND METHODS In all subjects, we evaluated ACTH at 8:00 a.m. in basal conditions and serum cortisol levels at 12:00 p.m. (F24) and at 9:00 a.m. after a 1-mg overnight dexamethasone suppression test and 24-h urinary free cortisol (UFC). In diabetic patients, we evaluated the presence of chronic complications (incipient nephropathy, asymptomatic neuropathy, background retinopathy, and silent macroangiopathy). Patients were subdivided according to the absence (group 1, n = 53) or presence (group 2, n = 117) of diabetes complications. RESULTS In group 2, UFC (125.2 +/- 4.6 nmol/24 h) and F24 (120.6 +/- 4.1 nmol/l) were higher than in group 1 (109.2 +/- 6.8 nmol/24 h, P = 0.057, and 99.7 +/- 6.1 nmol/l, P = 0.005, respectively) and in nondiabetic patients (101.7 +/- 5.9 nmol/24 h, P = 0.002, and 100.3 +/- 5.3 nmol/l, P = 0.003, respectively). In diabetic patients, the number of complications was associated with F24 (R = 0.345; P < 0.0001) and diabetes duration (R = 0.39; P < 0.0001). Logistic regression analysis showed that the presence of diabetes complications was significantly associated with F24, sex, duration of diabetes, and glycated hemoglobin. CONCLUSIONS In type 2 diabetic subjects, hypothalamic-pituitary-adrenal activity is enhanced in patients with diabetes complications and the degree of cortisol secretion is related to the presence and number of diabetes complications.
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Affiliation(s)
- Iacopo Chiodini
- Endocrine Unit, Department of Medical Sciences, University of Milan, Fondazione Policlinico, Mangiagalli e Regina Elena, IRCCS, Milan, Italy.
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Neuroendocrine Regulation of Natural Immunity. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s1567-7443(05)80017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Abstract
There is increasing evidence that an ongoing cytokine-induced acute-phase response (sometimes called low-grade inflammation, but part of a widespread activation of the innate immune system) is closely involved in the pathogenesis of type 2 diabetes and associated complications such as dyslipidemia and atherosclerosis. Elevated circulating inflammatory markers such as C-reactive protein and interleukin-6 predict the development of type 2 diabetes, and several drugs with anti-inflammatory properties lower both acute-phase reactants and glycemia (aspirin and thiazolidinediones) and possibly decrease the risk of developing type 2 diabetes (statins). Among the risk factors for type 2 diabetes, which are also known to be associated with activated innate immunity, are age, inactivity, certain dietary components, smoking, psychological stress, and low birth weight. Activated immunity may be the common antecedent of both type 2 diabetes and atherosclerosis, which probably develop in parallel. Other features of type 2 diabetes, such as fatigue, sleep disturbance, and depression, are likely to be at least partly due to hypercytokinemia and activated innate immunity. Further research is needed to confirm and clarify the role of innate immunity in type 2 diabetes, particularly the extent to which inflammation in type 2 diabetes is a primary abnormality or partly secondary to hyperglycemia, obesity, atherosclerosis, or other common features of the disease.
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Affiliation(s)
- John C Pickup
- Metabolic Unit, Guy's, King's and St. Thomas's School of Medicine, Guy's Hospital, London, UK.
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Merritt M, Bretthorst GL, Burgess SC, Sherry AD, Malloy CR. Sources of plasma glucose by automated bayesian analysis of2H NMR spectra. Magn Reson Med 2003; 50:659-63. [PMID: 14523948 DOI: 10.1002/mrm.10577] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Sources of blood glucose can be determined after oral ingestion of (2)H(2)O followed by isolation of plasma glucose and measurement of the relative (2)H enrichments in select positions within the glucose molecule. Typically, (2)H enrichments are obtained by mass spectrometry but (2)H NMR offers an alternative. Here it is demonstrated that the entire analysis may be automated by Bayesian analysis of a (2)H free induction decay signal of monoacetone glucose to obtain a direct readout of the relative contributions of glycogenolysis, glycerol, and phosphoenol pyruvate to plasma glucose production. Furthermore, Markov Chain Monte Carlo (MCMC) simulations of the posterior probability density provide uncertainties in all metabolic parameters from a single patient, thereby allowing comparisons in glucose metabolism from one individual to another. The combined MCMC Bayesian methodology is operationally simple and requires little intervention from the operator.
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Affiliation(s)
- Matthew Merritt
- Department of Radiology, The Mary Nell and Ralph B. Rogers Magnetic Resonance Center, University of Texas Southwestern Medical Center, Dallas, Texas 75235-9085, USA.
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