Background: Daily stress may compound the burden of diabetes. This analysis investigated whether frequency or severity of stress had an influence on glycemic control (HbA1c) and mortality in adults with diabetes.

Methods: Data from the second and third wave of the national longitudinal survey of Midlife Development in the United States (MIDUS), conducted between 1995 and 2014, was used. A total of 141 adults with diagnosed and undiagnosed diabetes, based on HbA1c and self-report of diagnosis, completed the national study of daily experiences (NSDE) project during which questions were asked about daily stress type, frequency, and impact for eight consecutive nights. General linear models investigated the relationship between stress and HbA1c. Cox proportional hazard models estimated hazard ratios using national death index information linked to MIDUS data.

Results: On average, this population of adults with diabetes reported 3.1 days with a stressor and 3.9 stressors in an 8-day period. While 21.9% reported only one stressor type, 72.3% reported more than one stressor type. No significant relationships existed between number of days with stressor, average number of stressors, or number of stressor types. Average physical symptom severity reported in relationship to stressful events was negatively associated with HbA1c (-0.20, p=0.04). The average stressor severity and average stressor negative affect were both significantly associated with mortality (HR=0.45, p=0.04 and HR=0.17, p=0.03, respectively).

Conclusions: Daily stress may influence outcomes for adults with diabetes; in particular, severity of stressors experienced, severity of physical symptoms related to stressors, and negative affect (negative emotions and poor self-image) related to stressors. Interventions addressing psychosocial factors, such as daily stress, in individuals with diabetes may need to focus on helping individuals mitigate the impact of stress rather than decrease the amount of stress in their lives.


R.J. Walker: None. E. Garacci: None. J.A. Campbell: None. L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc..

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