Background
Methods
Participants and procedures
Midnight salivary cortisol (MSC)
Season, self-reported depression, clinical psychiatric diagnoses and life-style
Metabolic variables and hypoglycemia episodes
Statistical analysis
Results
All patients (n = 196) | Men (n = 106) | Women (n = 90) | P1
| ||
---|---|---|---|---|---|
Age (years) | 41.3 ± 11.7 | 42.6 ± 12.0 | 39.7 ± 11.2 | 0.0832
| |
Diabetes duration (years) | 21.1 ± 12.2 | 22.3 ± 12.5 | 19.7 ± 11.8 | 0.142
| |
High MSC | |||||
MSC ≥9.3 nmol/L | 34 (17) | 17 (16) | 17 (19) | 0.71 | |
Psychiatric variables | |||||
Depression3
| 20 (10) | 12 (11) | 8 (9) | 0.64 | |
Clinical psychiatric diagnoses | 27 (14) | 8 (8) | 19 (21) | 0.007 | |
Life style factors | |||||
Smoking4
| 16 (9) | 11 (11) | 5 (6) | 0.30 | |
Physical inactivity5
| 19 (10) | 10 (10) | 9 (11) | > 0.99 | |
Metabolic variables and hypoglycemia | |||||
HbA1c | mmol/mol | 62 ± 13 | 62 ± 10 | 64 ± 15 | 0.302
|
% | 7.9 ± 1.1 | 7.8 ± 1.0 | 8.0 ± 1.3 | ||
HbA1c >70 mmol/mol (>8.6%) | 50 (26) | 22 (21) | 28 (31) | 0.10 | |
Abdominal obesity6
| 29 (15) | 8 (8) | 21 (24) | 0.002 | |
Hypertension | 106 (54) | 65 (61) | 41 (46) | 0.031 | |
Hyperlipidemia | 167 (85) | 96 (91) | 71 (79) | 0.027 | |
Severe hypoglycemia episodes7
| 9 (5) | 4 (4) | 5 (5) | 0.74 | |
Medication | |||||
Antidepressants | 13 (7) | 4 (4) | 9 (10) | 0.092 | |
Antihypertensive medication | 60 (31) | 38 (36) | 22 (24) | 0.090 | |
Lipid lowering drugs | 93 (47) | 53 (50) | 40 (44) | 0.48 | |
Inhaled steroids | 15 (8%) | 4 (4) | 11 (12) | 0.032 |
MSC for all patients included in the study
Midnight salivary cortisol (nmol/L) | ||||
---|---|---|---|---|
n (%) | Median (q1, q3;range) | P1
| ||
All participants | 196 | 5.0 (3.1, 7.5; 1.9–47.0) | ||
Gender | ||||
Men | 106 (54) | 4.6 (3.1, 6.8; 1.9–47.0) | 0.062 | |
Women | 90 (46) | 5.6 (3.2, 8.0; 1.9–23.0 ) | ||
Psychiatric variables | ||||
Depression2
| Yes | 20 (10) | 7.7 (5.0, 13.0; 1.9–31.0) | 0.005 |
No | 176 (90) | 4.8 (3.0, 7.1; 1.9–47.0) | ||
Depression2 and antidepressants (Sub analysis) | ||||
Depression2, using antidepressants | 5 (2) | 8.7 (3.3; 18.0; 3.0–26.0) | 0.76 | |
Depression2, not using antidepressants | 15 (8) | 6.7 (5.1; 13.0; 1.9–31.0) | ||
No depression2, using antidepressants | 8 (4) | 4.4 (3.1; 8.6; 2.9–14.0) | 0.90 | |
No depression2, not using antidepressants | 168 (86) | 4.8 (3.0; 7.1; 1.9–47.0) | ||
Clinical psychiatric diagnoses | Yes | 27 (14) | 5.3 (3.7, 9.4; 1.9–26.0) | 0.28 |
No | 169 (86) | 5.0 (3.0, 7.4; 1.9–47.0) | ||
Life style factors | ||||
Smoking | Yes | 16 (9) | 9.0 (6.6, 11.8; 2.3–47.0) | <0.001 |
No | 170 (91) | 4.8 (3.0, 7.0; 1.9–31.0) | ||
Physical inactivity | Yes | 19 (10) | 6.3 (4.3, 13.0; 1.9–31.0) | 0.050 |
No | 165 (90) | 4.9 (3.0, 7.2; 1.9–47.0) | ||
Metabolic variables and hypoglycemia episodes | ||||
HbA1c >70 mmol/mol (>8.6%) | Yes | 50 (26) | 5.3 (3.7, 7.6; 1.9–31.0) | 0.26 |
No | 146 (74) | 4.8 (3.0, 7.5; 1.9–47.0) | ||
Abdominal obesity, men3
| Yes | 8 (8) | 3.8 (2.5, 5.4; 1.9–31.0) | 0.37 |
No | 96 (92) | 4.8 (3.1, 7.2; 1.9–47.0) | ||
Abdominal obesity, women4
| Yes | 21 (24) | 7.1 (5.1, 8.8; 2.9–20) | 0.030 |
No | 65 (76) | 5.0 (2.9, 7.8; 1.9–23.0) | ||
Severe hypoglycemia episodes5
| Yes | 9 (5) | 5.4 (3.4, 6.5; 2.4–11.0) | 0.96 |
No | 186 (95) | 5.0 (3.1, 7.6; 1.9–47.0) | ||
Medication | ||||
Antidepressants | Yes | 13 | 4.4 (3.3, 9.7; 2.9–26.0) | 0.53 |
No | 183 | 5.0 (3.1, 7.4; 1.9–47.0) | ||
Inhaled steroids | Yes | 15 (8) | 5.4 (3.0, 7.6; 2.3–11.0) | 0.88 |
No | 181 (92) | 5.0 (3.1, 7.5; 1.9–47.0) |
Seasons | |||||
---|---|---|---|---|---|
Spring1(n = 79) | Summer2(n = 50) | Autumn/winter3(n = 67) | P4
| ||
MSC | nmol/L | 6.7 (4.7, 9.3) | 4.6 (2.8, 6.8) | 3.5 (2.7, 5.5) | <0.0015
|
MSC ≥9.3 nmol/L | Yes | 20 (25) | 9 (18) | 5 (8) | 0.013 |
No | 59 (75) | 41 (82) | 62 (92) | ||
Age (years) | 45.0 (32.0, 52.0) | 40.0 (28.0, 48.2) | 44.0 (32.0, 53.0) | 0.0905
| |
Physical inactivity6
| Yes | 9 (12) | 7 (15) | 3 (5) | 0.21 |
No | 66 (88) | 41 (85) | 58 (95) | ||
Gender | Men | 39 (49) | 32 (64) | 35 (49) | 0.25 |
Women | 40 (51) | 18 (36) | 32 (51) | ||
High HbA1c7
| Yes | 23 (29) | 15 (30) | 12 (18) | 0.21 |
No | 56 (71) | 35 (70) | 55 (82) | ||
HbA1c | mmol/mol | 63 (53, 71) | 64 (55, 72) | 60 (53, 68) | 0.325
|
% | 7.9 (7.0, 8.6) | 8.0 (7.2, 8.8) | 7.7 (7.0, 8.4) | ||
Smoking8
| Yes | 9 (12) | 4 (8) | 3 (5) | 0.32 |
No | 66 (88) | 45 (92) | 59 (95) | ||
Depression9
| Yes | 11 (14) | 4 (8) | 5 (8) | 0.41 |
No | 68 (86) | 46 (92) | 62 (92) |
High midnight salivary cortisol (≥9.3 nmol/L) | |||||
---|---|---|---|---|---|
COR (95% CI) | P1
| AOR (95% CI) | P2
| ||
Smoking | 5.5 (1.9–16.1) | 0.002 | 5.5 (1.6–18.5) | 0.006 | |
Age (per year) | 1.06 (1.02–1.10) | 0.002 | 1.08 (1.03–1.13) | 0.001 | |
Season | |||||
Spring | 4.2 (1.5–11.9) | 0.007 | 4.3 (1.4–13.7) | 0.013 | |
Summer | 2.7 (0.9–8.7) | 0.09 | 3.4 (0.9–13.0) | 0.07 | |
Autumn/winter (reference) | 1 | 1 | |||
Physical inactivity | 3.0 (1.1–8.3) | 0.036 | 3.9 (1.1–13.4) | 0.032 | |
Depression | 4.9 (1.9–13.1) | 0.001 | 3.1 (1.0–9.2) | 0.047 | |
Women | 1.2 (0.6–2.6) | 0.66 | 2.2 (0.9–5.2) | 0.089 | |
Antidepressants | 2.3 (0.7–7.8) | 0.20 | - | 0.76 | |
Inhaled steroids | 0.3 (0.04–2.5) | 0.28 | - | - | |
Diabetes duration | 1.01 (0.98–1.04) | 0.40 | - | - | |
HbA1c | mmol/mol (per unit) | 1.01 (0.98–1.04) | 0.57 | - | - |
% (per unit) | 1.10 (0.80–1.51) | ||||
Abdominal obesity, men | 0.7 (0.1–6.2) | 0.76 | - | - | |
Abdominal obesity, women | 0.9 (0.3–3.3) | 0.92 | - | - |
MSC in non-depressed (self-reported), non-smoking and physically active patients
Associations with self-reported depression
Self-reported depression | ||||
---|---|---|---|---|
COR (95% CI) | P1
| AOR (95% CI) | P2
| |
MSC ≥9.3 nmol/L | 4.9 (1.9–13.1) | 0.001 | 4.4 (1.5–13.0) | 0.007 |
HbA1c >70 mmol/L (>8.6%) | 4.3 (1.7–11.1) | 0.003 | 4.2 (1.5–11.8) | 0.007 |
Antidepressants | 7.0 (2.0–24.1) | 0.002 | 4.9 (1.2–20.8) | 0.030 |
Women | 0.8 (0.3–2.0) | 0.58 | - | 0.17 |
Physical inactivity3
| 3.6 (1.1–11.3) | 0.030 | - | 0.18 |
Age (per year) | 1.04 (1.0–1.1) | 0.060 | - | 0.29 |
Season | ||||
Spring | 2.0 (0.7–6.1) | 0.22 | - | 0.33 |
Summer | 1.1 (0.3–4.2) | 0.91 | - | 0.33 |
Autumn/winter (reference) | 1 | 1 | ||
Smoking3
| 2.1 (0.5–8.0) | 0.29 | - | 0.68 |
Clinical psychiatric diagnosis | 7.2 (2.6–19.7) | <0.001 | - | - |