Introduction & Objective: Stress is implicated as a factor in immune reactivity and autoimmune disorders. Adverse experiences and chronic stress may be associated with low morning cortisol levels. Here, we tested if morning saliva cortisol is associated with the development of islet autoimmunity (IA).

Methods: Saliva was collected 30 minutes upon awakening and assayed for cortisol in 1049 children enrolled in The Environmental Determinants of Diabetes in the Young (TEDDY) study at 42 months. Using Cox proportional hazards models, we examined morning log2 cortisol at 42 months in relation to risk of IA between 4 and 15 years of age (any IA: n=89; GADA-first: n=53; IAA-first, n=23) in addition to TEDDY published factors associated with IA.

Results: Morning saliva cortisol (median log2=3.34) at 42 months is inversely associated with the risk of IA from 4 years of age (HR (95%CI) per log2 increase (0.65 (0.51-0.83), p=0.0005) adjusting for HLA-DR-DQ, diabetes family history, sex, weight-z score at age 12 months, and country. Both high (HR=0.19) and low (HR=1.95) morning cortisol levels are significantly associated with risk of IA, independently, as compared to 79% of children with log2 cortisol levels between 2-3.99 (Figure).

Conclusion: These findings suggest that morning saliva cortisol at 42 months of age is inversely associated with risk of IA in genetically at-risk children followed until 15 years of age.

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Disclosure

K. Vehik: None. K.F. Lynch: None. H.M. Parikh: None. Å. Lernmark: Advisory Panel; DiaMyd Medical AB, Stockholm, Sweden. M. Rewers: Advisory Panel; Sanofi. Other Relationship; Sanofi. Consultant; Janssen Pharmaceuticals, Inc. Research Support; Juvenile Diabetes Research Foundation (JDRF). Consultant; Provention Bio, Inc. Research Support; Hemsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases. R. McIndoe: None. J. Toppari: None. A. Ziegler: None. B. Akolkar: None. W. Hagopian: Research Support; Janssen Pharmaceuticals, Inc., Provention Bio, Inc. Consultant; Sanofi-Aventis U.S., Randox R & D. T.M. Brusko: None. J. Krischer: None. R.L. Roth: None. S.B. Johnson: None.

Funding

NIH NIDDK (U01 DK63829, U01 DK63861, U01 DK63821, U01 DK63865, U01 DK63863, U01 DK63836, U01 DK63790, UC4 DK63829, UC4 DK63861, UC4 DK63821, UC4 DK63865, UC4 DK63863, UC4 DK63836, UC4 DK95300, UC4 DK100238, UC4 DK106955, UC4 DK112243, UC4 DK117483, U01 DK124166, U01 DK128847, and Contract No. HHSN267200700014C)

© 2024 by the American Diabetes Association
2024
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