期刊
ANNALS OF THE NEW YORK ACADEMY OF SCIENCES
卷 1391, 期 1, 页码 20-34出版社
WILEY
DOI: 10.1111/nyas.13217
关键词
cortisol; stress; depression; diabetes; hypothalamic-pituitary-adrenal axis
资金
- National Heart, Lung, and Blood Institute [NO1-HC-95159, NO1-HC-95165, NO1-HC-95169]
- National Institute of Diabetes and Digestive and Kidney Diseases [T32 DK062707]
- [RO1 HL10161-01A1]
- [R21 DA024273]
Controversy exists over the role of stress and depression in the pathophysiology of type 2 diabetesmellitus. Depression has been shown to increase the risk for progressive insulin resistance and incident type 2 diabetesmellitus in multiple studies, whereas the association of stress with diabetes is less clear, owing to differences in study designs and in forms and ascertainment of stress. The biological systems involved in adaptation that mediate the link between stress and physiological functions include the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous and immune systems. The HPA axis is a tightly regulated system that represents one of the body's mechanisms for responding to acute and chronic stress. Depression is associated with cross-sectional and longitudinal alterations in the diurnal cortisol curve, including a blunted cortisol awakening response and flattening of the diurnal cortisol curve. Flattening of the diurnal cortisol curve is also associated with insulin resistance and type 2 diabetes mellitus. In this article, we review and summarize the evidence supporting HPA axis dysregulation as an important biological link between stress, depression, and type 2 diabetes mellitus.
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