Biopsychosocial pathways linking subjective socioeconomic disadvantage to glycemic control in youths with type I diabetes.
Biopsychosocial pathways linking subjective socioeconomic disadvantage to glycemic control in youths with type I diabetes.
复制标题
将主观社会经济劣势与 I 型糖尿病青少年血糖控制联系起来的生物心理社会途径。
DOI：
10.1016/j.psyneuen.2017.01.033
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发表时间：
2017
影响因子：
3.7
通讯作者：
Slatcher,RichardB
中科院分区：
文献类型：
--
作者：
Zilioli,Samuele;Ellis,DeborahA;Carré,JustinM;Slatcher,RichardB
患有1型糖尿病（T1 D）的老年青少年和年轻人（OAYA）生活在社会经济劣势（SED）的环境中，不成比例地患有血糖控制不良和相关的健康并发症。尽管SED可能带来各种风险，但它可能会加剧糖尿病相关的压力水平，这反过来可能导致观察到的健康结果差异。本研究的主要目的是调查主观SED，糖尿病相关的感知压力，和昼夜皮质醇分泌在城市OAYA与T1 D之间的关系。第二个目标是确定皮质醇是否与血糖指标（HbA 1c和平均血糖）相关。在受T1 D影响的17-20岁OAYA（n= 61）中进行分析，他们提供了四天的每日唾液样本，血糖控制措施（即，HbA 1c和通过动态血糖监测仪评估的平均血糖），并完成心理社会问卷调查。我们发现，主观SED与通过糖尿病相关的压力，一个平坦的昼夜皮质醇节律。反过来，皮质醇节律变平与HbA 1c水平升高相关，但与通过动态血糖监测仪评估的平均血糖无关。这些结果代表了关于远端社会因素（即，主观SED）和近端心理过程（糖尿病相关的感知压力）与条件相关的生物学机制（即，升高的HbA 1c），通过与健康有关的广泛生物学途径（即，皮质醇斜率变平）。
Older adolescent and young adults (OAYA) with type 1 diabetes (T1D) living in contexts of socio-economic disadvantage (SED) suffer disproportionately from poor glycemic control and related health complications. Although SED may convey a variety of risks, it may exacerbate diabetes-related stress levels, which in turn may account for observed disparities in health outcomes. The primary goal of the present study was to investigate the relationship between subjective SED, diabetes-related perceived stress, and diurnal cortisol secretion in urban OAYA with T1D. A secondary goal was to determine if cortisol was related to measures of blood glucose (HbA1c and mean blood glucose). Analyses were conducted among OAYA ages 17–20 years (n= 61) affected by T1D, who provided daily saliva samples for four days, measures of glycemic control (i.e., HbA1c and mean blood glucose assessed via Continuous Glucose Monitor), and completed psychosocial questionnaires. We found that subjective SED was associated with a flatter diurnal cortisol rhythm via diabetes-related stress. Flattened cortisol rhythm was, in turn, associated with higher levels of HbA1c, but not with mean blood glucose assessed via Continuous Glucose Monitor. These results represent some of the first empirical evidence on how distal social factors (i.e., subjective SED) and proximal psychological processes (diabetes-related perceived stress) are connected to condition-relevant biological mechanisms (i.e., elevated HbA1c), via broad biological pathways implicated in health (i.e., flatter cortisol slope).