Type II Diabetes and Emotional Stress…Part 2

Hi, I’m Will Smith AKA Thunder of the American Gladiators.

My interest in competing and winning championship titles began to wane as my interest in the scientific discipline of diet and exercise neuroendocrinology intensified. This particular scientific elective was initially the result of my younger brother’s diagnoses and longtime struggle with Type I Diabetes. My determination to research and develop a diet and exercise related curriculum that would improve my brother’s ability to play sports and live a normal life (while also enabling him to achieve optimal levels of health, fitness and performance, minimize the use of insulin and reduce his risk of developing further cardiovascular related diseases and complications) would eventually become my obsession and is known today as the INTRAFITT Individualized Nutrition and Exercise Program.

I refer often to the following article and I am sharing it with you in several parts.  This is Part 2.


Type 2 diabetes mellitus is a serious and common metabolic disorder. The World Health Organization (WHO) has estimated the number of persons with diabetes worldwide at more than 220 million (WHO, 2009). These figures are expected to rise to 366 million by 2030 (Wild et al., 2004). Besides, diabetes mellitus is associated with a two- to four-fold increased risk of coronary heart disease and also an increased risk for microvascular diseases such as retinopathy, nephropathy, and neuropathy. Patients with type 2 diabetes also have a doubled risk level for co-morbid depression compared to healthy controls, hampering the quality of life of patients (Pouwer et al., 2003; Schram et al., 2009). Moreover, a considerable number of depressed patients suffer from high levels of diabetes-specific emotional stress (Pouwer et al., 2005; Kokoszka et al., 2009). Important factors contributing to the increasing prevalence of type 2 diabetes are obesity, physical inactivity, and an increase in the number of individuals older than 65 years (Wild et al., 2004).

Interestingly, stress has long been suspected as having important effects on the development of diabetes. More than 400 years ago, the famous English physician Thomas Willis (1621-1675) noted that diabetes often appeared among persons who had experienced significant life stresses, sadness, or long sorrow (Willis, 1675). One of the first systematic studies testing Willis’s hypothesis was described in 1935, by the American psychiatrist Dr. W. Menninger, who postulated the existence of psychogenic diabetes and described a “diabetic personality” (Menninger, 1935). Almost thirty years later, P.F. Slawson et al. described in the Journal of the American Medical Association that 80% of a group of 25 adult diabetes patients gave a history of antecedent stress mainly in terms of losses, 1-48 months prior to the onset of diabetes (Slawson et al., 1963). However, this study had several important limitations, including a very small sample size, a retrospective, uncontrolled design, and a high risk of selection bias. More recently, numerous studies have been performed, elucidating the role of emotional stress as a risk factor for the development of type 2 diabetes. The majority of these studies focus on depression. However, there is growing evidence that other forms of emotional stress contribute to the development of type 2 diabetes as well.

The aim of this review is to provide an overview of studies on the relationship between different forms of emotional stress and the risk of developing type 2 diabetes mellitus, involving depression, anxiety, life events or traumata, general emotional stress, work stress, and sleeping problems. The different pathways, limitations of these findings, and implications for future research will also be discussed.

Any questions or concerns on this article, please email me at gladiator@intrafitt.com.