LAUSR

There is evidence that psychological distress increases the risk of type 2 diabetes (T2D), but implications for prevention remain elusive. Among adults without diabetes in Germany, Nübel et al. evaluated the cross-sectional association between perceived chronic stress and the German Diabetes Risk Score, a validated tool for T2D risk prediction incorporating self-reported information on behavioral and biological T2D risk factors. High chronic stress was independently associated with an increase in predicted 5-year T2D risk. ABSTRACT Objective There is evidence that psychological distress increases the risk of type 2 diabetes (T2D), but implications for prevention remain elusive. We examined the association between chronic stress and the German Diabetes Risk Score (GDRS) among adults without diabetes in Germany. Methods The study population consisted of 4654 persons aged 18 to 64 years without known diabetes drawn from the German Health Interview and Examination Survey for Adults (2008–2011). The predicted 5-year T2D risk (in percent) was estimated using the GDRS. Perceived chronic stress was assessed by the Screening Scale of the Trier Inventory for the Assessment of Chronic Stress and categorized into “up to average,” “above average,” and “high.” The cross-sectional association of chronic stress with log-transformed GDRS (expressed as geometric mean ratio [GMR]) was analyzed in multivariable linear regression models. Covariables included age, sex, community size, region, educational level, living alone, social support, depression, and alcohol use. Results The mean predicted 5-year T2D risk rates were 2.7%, 2.9%, and 3.0% for chronic stress up to average, above average, and high chronic stress, respectively. Adjusted mean predicted 5-year risk was significantly higher among persons with chronic stress above average (GMR = 1.10, 95% confidence interval = 1.02–1.19) and high stress (GMR = 1.21, 95% CI = 1.06–1.39) compared with persons with chronic stress up to average. No interactions with sex or other covariables were found. Conclusions Perceived chronic stress is independently associated with an increased predicted T2D risk in cross-sectional analysis and should be considered as T2D risk factor in longitudinal studies.