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

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Författare/Namn	Melin, Eva
Titel	Depression, smoking, physical inactivity and season independently associated with midnight salivary cortisol in type 1 diabetes
Anmärkning: Innehållsbeskrivning, sammanfattning	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.
Ämne	Depression Midnight salivary cortisol Type 1 diabetes smoking Physical activity Season HbA1c
Medarbetare	Thunander, Maria Författare/medförfattare Landin-Olsson, Mona Författare/medförfattare Hillman, Magnus Författare/medförfattare Thulesius, Hans Författare/medförfattare
Institutionsnamn	Lunds universitet. Lund University. Lunds universitet. Lund University. Lunds universitet. Lund University.
Värdpublikation	BMC Endocrine Disorders BioMed Central ISSN 1472-6823 14, s. 75 14<75
Elektronisk adress och åtkomst (URI)	Till lärosätets (lu) databas H:\data\maria th 2014.pdf Fulltext
Antal i kö:	0 (0)

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*24510$aDepression, smoking, physical inactivity and season independently associated with midnight salivary cortisol in type 1 diabetes
*5203 $8eng$aBACKGROUND: 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.
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*653  $aDepression
*653  $aMidnight salivary cortisol
*653  $aType 1 diabetes
*653  $asmoking
*653  $aPhysical activity
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*7102 $8eng$aLund University.$bFaculty of Medicine.$bDepartment of Clinical Sciences, Malmö.$bEndocrinology.$bDiabetes and Endocrinology.$0(SwePub:lu)
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