Psychological Distress Predicts HbA1c Trajectories among Type 1 Diabetic Adolescents / El estrés psicológico predice las trayectorias de HbA1c en adolescentes diabéticos tipo 1

Abstract Diabetic adolescents have poor metabolic control. We aimed to characterize the longitudinal association between the stress-related domains of emotional burden (EB), physician related-distress (PD), regimen-related distress (RD), diabetes-related interpersonal distress (ID), and hemoglobin glycosylated (HbA1c) trajectories among Type 1 diabetics Chilean adolescents. Thirty-two Type 1 diabetic adolescents (Mage=15.97; SD=3.45) were followed for one year. HbA1c was assessed at three time points, and a stress measure was obtained. Using a longitudinal growth curve modeling, a marginal overall negative linear trend was found in HbA1c (b = -0.23, p = 0.096). There was an interaction between time and PD (b = -0.33, p < 0.05), and a main effect of EB, RD, and ID on HbA1c. Psychological stress domains predict metabolic control trajectories. Monitoring diabetes specific stress may be a useful tool to identify adolescents at risk for poor control, and interventions that reduce such stress might lead to better management of diabetes in adolescents.

Resumen Los adolescentes diabéticos tienen un pobre control metabólico. El propósito de este estudio fue caracterizar la asociación longitudinal entre el estrés emocional (EB), estrés con el médico (PD), estrés con el tratamiento (RD) y estrés interpersonal (ID), con trayectorias de hemoglobinas glicosiladas (HbA1c) en adolescentes diabéticos tipo 1 (DM1). Treinta y dos adolescentes DM1 (Medad = 15.97, DE = 3.45) fueron seguidos un año. Se obtuvo la HbA1c tres veces en el año, más un auto-reporte de estrés. Análisis de curvas de crecimiento predijeron una tendencia lineal negativa en la trayectoria de HbA1c (b = -0.23, p = 0.096). Hubo una interacción entre el tiempo y PD (b = -0.33, p ≤ 0.05) y los efectos principales de EB, RD, e ID en HbA1c. Se concluye que el estrés psicológico predice trayectorias de HbA1c. Monitorear dominios específicos de estrés podría ser útil para identificar adolescentes con riesgo de tener pobre HbA1c, e intervenciones que reduzcan el estrés podrían ayudar a manejar la diabetes en adolescentes.

How stress gets under the skin o cómo el estrés psicológico se introduce bajo la piel / How stress gets under the skin

How psychological stress gets under the skin and contributes to increase the odds for the onset and progression of chronic diseases has been object of abundant research. In this literature review, evidence about the role that both acute (natural phenomenon, marital conflict, a social evaluative task) and chronic stress (stress at work, and the perception of being discriminated) as well as interpersonal stress have on physical health, is examined. Behavioral (lack of physical activity, smoking, lack of adherence) and physiological (dysregulation of the hypothalamic-pituitary-adrenal axis, sympathetic-adrenal-medullary axis, immune system and inflammatory response) mechanisms through which psychological stress may contribute to the onset and progression of cardiovascular disease (altering blood pressure, heart rate reactivity, hemoconcentration and pro-coagulation function), and two key processes involved in cancer progression (angiogenesis and metastasis) are discussed. Finally, how social support may moderate the association among psychological stress and physical health is described.