Although the commonly recognized primary predictors of type 2 diabetes (T2DM) include obesity and insulin resistance, it is less clear why some folks with obesity and/or insulin resistance progress to T2DM and others do not. Could psychological stress be a predictor? Results from the Whitehall II Cohort Study suggest that this is indeed the case.

The Whitehall II Cohort Study is comprised of adults employed by the London, England, department of civil service (n = 6895 men and 3413 women) followed prospectively. Data were obtained from a subpopulation of this cohort during various cycles (average observation cycle = 5.46 years) from 1991-2009 to ascertain incidence of T2DM in previously non-diabetic subjects. Psychological stress was measured with the General Health Questionnaire (GHQ-30); a GHQ-30 score > 4 was categorized as “stressed.” Proclivity to develop diabetes was further stratified into quartiles by the Framingham Offspring T2DM Risk Score (FOTRS).

Among prediabetic adults in the highest quartile of FOTRS, the adjusted odds ratio for developing T2DM was more than 2-fold greater in stressed individuals than in persons with low stress scores. The mechanism(s) by which stress increases progression to T2DM is not understood. The authors posit that interventions designed to prevent progression from prediabetes to diabetes might well show greater consideration for the potential impact of emotional stressors like depression and anxiety.