Hackett, Ruth A; Steptoe, Andrew; Kumari, Meena; (2014) Association of Diurnal Patterns in Salivary Cortisol With Type 2 Diabetes in the Whitehall II Study. The Journal of Clinical Endocrinology & Metabolism , 99 (12) pp. 4625-4631. 10.1210/jc.2014-2459.

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Abstract

Context: The hypothalamic pituitary-adrenal (HPA) axis is thought to play a role in Type 2 Diabetes (T2D). However, the evidence for an association between diurnal cortisol patterns and T2D is equivocal. // Objective: The aim was to examine the association of cortisol patterns throughout the day with T2D status in a community-dwelling population. // Design: This was a cross-sectional study of T2D status and salivary cortisol from phase 7 (2002-2004) of the Whitehall II study, United Kingdom. // Setting: The occupational cohort was originally recruited in 1985-1988. // Participants: 3508 white men and women including 238 participants with T2D aged 50-74 years with complete information on cortisol secretion. // Outcome Measures: We measured diurnal cortisol (nmol/l) patterns from six saliva samples obtained over the course of a normal day: at waking, +30 min, +2.5 h, +8 h, +12 h, and bedtime. The cortisol awakening response and slope in diurnal secretion were calculated. // Results: T2D status was associated with a flatter slope in cortisol decline across the day (B = 0.004, C.I. = 0.001 to 0.007, p = 0.014) and greater bedtime cortisol (B = 0.063, C.I. = 0.010 to 0.117, p =0.020) independent of a wide range of covariates measured at the time of cortisol assessment. There was no association between morning cortisol, the cortisol awakening response and T2D (p > 0.05). // Conclusions: In this non-clinical population, T2D was associated with a flatter slope in cortisol levels across the day and raised bedtime cortisol values.

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