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Depression, smoking, physical inactivity and season independently associated with midnight salivary cortisol in type 1 diabetes

Melin, Eva LU ; Thunander, Maria LU ; Landin-Olsson, Mona LU ; Hillman, Magnus LU and Thulesius, Hans LU (2014) In BMC Endocrine Disorders 14.
Abstract
BACKGROUND: Disturbances of the circadian rhythm of cortisol secretion are associated with depression, coronary calcification, and higher all-cause and cardiovascular mortality.The primary aim of this study was to test the associations between midnight salivary cortisol (MSC), depression and HbA1c, and control for behavioural, environmental and intra individual factors with possible impact on cortisol secretion, like smoking, physical inactivity, season, medication, diabetes duration, severe hypoglycemia episodes, age and gender in patients with type 1 diabetes. Secondary aims were to present MSC levels for a reference group of non-depressed type 1 diabetes patients with a healthy life style (physically active and non-smoking), and to... (More)
BACKGROUND: Disturbances of the circadian rhythm of cortisol secretion are associated with depression, coronary calcification, and higher all-cause and cardiovascular mortality.The primary aim of this study was to test the associations between midnight salivary cortisol (MSC), depression and HbA1c, and control for behavioural, environmental and intra individual factors with possible impact on cortisol secretion, like smoking, physical inactivity, season, medication, diabetes duration, severe hypoglycemia episodes, age and gender in patients with type 1 diabetes. Secondary aims were to present MSC levels for a reference group of non-depressed type 1 diabetes patients with a healthy life style (physically active and non-smoking), and to explore seasonal variations. METHODS: A cross-sectional population based study of 196 patients (54% men and 46% women) aged 18-59 years that participated in a randomized controlled trial targeting depression in type 1 diabetes. Depression was assessed by the Hospital Anxiety and Depression Scale-depression subscale. MSC, HbA1c, serum-lipids, blood pressure, waist circumference and data from medical records and the Swedish National Diabetes Registry were collected. RESULTS: Thirty four patients (17%) had MSC >=9.3 nmol/L, which was associated with smoking (AOR 5.5), spring season (AOR 4.3), physical inactivity (AOR 3.9), self-reported depression (AOR 3.1), and older age (per year) (AOR 1.08). HbA1c >70 mmol/mol (>8.6%) (AOR 4.2) and MSC >=9.3 nmol/L (AOR 4.4) were independently linked to self-reported depression. Season was strongly associated with MSC levels and no other variables studied showed seasonal variations. In a reference group of 137 non-depressed patients with a healthy life style (physically active, non-smoking) the median MSC level was 4.6 nmol/L (range 1.9-23.0). CONCLUSIONS: In this study of patients with type 1 diabetes high MSC was linked to smoking, physical inactivity, depression, season and older age. Thus a high cortisol value identified three major targets for treatment in type 1 diabetes. (Less)
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Contribution to journal
publication status
published
subject
keywords
Midnight salivary cortisol, Depression, Type 1 diabetes, Smoking, Physical activity, Season, HbA1c
in
BMC Endocrine Disorders
volume
14
publisher
BioMed Central
external identifiers
  • wos:000344703900001
  • scopus:84926657738
ISSN
1472-6823
DOI
10.1186/1472-6823-14-75
language
English
LU publication?
yes
id
390cf65a-6f8c-4b1f-9408-cba5bb68b520 (old id 4814328)
date added to LUP
2015-01-07 11:02:52
date last changed
2017-10-01 04:05:47
@article{390cf65a-6f8c-4b1f-9408-cba5bb68b520,
  abstract     = {BACKGROUND: Disturbances of the circadian rhythm of cortisol secretion are associated with depression, coronary calcification, and higher all-cause and cardiovascular mortality.The primary aim of this study was to test the associations between midnight salivary cortisol (MSC), depression and HbA1c, and control for behavioural, environmental and intra individual factors with possible impact on cortisol secretion, like smoking, physical inactivity, season, medication, diabetes duration, severe hypoglycemia episodes, age and gender in patients with type 1 diabetes. Secondary aims were to present MSC levels for a reference group of non-depressed type 1 diabetes patients with a healthy life style (physically active and non-smoking), and to explore seasonal variations. METHODS: A cross-sectional population based study of 196 patients (54% men and 46% women) aged 18-59 years that participated in a randomized controlled trial targeting depression in type 1 diabetes. Depression was assessed by the Hospital Anxiety and Depression Scale-depression subscale. MSC, HbA1c, serum-lipids, blood pressure, waist circumference and data from medical records and the Swedish National Diabetes Registry were collected. RESULTS: Thirty four patients (17%) had MSC >=9.3 nmol/L, which was associated with smoking (AOR 5.5), spring season (AOR 4.3), physical inactivity (AOR 3.9), self-reported depression (AOR 3.1), and older age (per year) (AOR 1.08). HbA1c >70 mmol/mol (>8.6%) (AOR 4.2) and MSC >=9.3 nmol/L (AOR 4.4) were independently linked to self-reported depression. Season was strongly associated with MSC levels and no other variables studied showed seasonal variations. In a reference group of 137 non-depressed patients with a healthy life style (physically active, non-smoking) the median MSC level was 4.6 nmol/L (range 1.9-23.0). CONCLUSIONS: In this study of patients with type 1 diabetes high MSC was linked to smoking, physical inactivity, depression, season and older age. Thus a high cortisol value identified three major targets for treatment in type 1 diabetes.},
  articleno    = {75},
  author       = {Melin, Eva and Thunander, Maria and Landin-Olsson, Mona and Hillman, Magnus and Thulesius, Hans},
  issn         = {1472-6823},
  keyword      = {Midnight salivary cortisol,Depression,Type 1 diabetes,Smoking,Physical activity,Season,HbA1c},
  language     = {eng},
  publisher    = {BioMed Central},
  series       = {BMC Endocrine Disorders},
  title        = {Depression, smoking, physical inactivity and season independently associated with midnight salivary cortisol in type 1 diabetes},
  url          = {http://dx.doi.org/10.1186/1472-6823-14-75},
  volume       = {14},
  year         = {2014},
}