The significance of an impaired psychosocial stress response on therelease of reactive metabolites as a possible cause of diabeticcomplications

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Previous research showed that in diabetes mellitus reactive metabolites such as methylglyoxal are elevated and accumulate. This can lead to long-term diabetic complications such as retinopathy, nephropathy, albminuria and/or neuropathy. There are also studies indicating that psychosocial stress leads to the accumulation of reactive metabolites. The goal of this proposed project is to examine and understand the association between psychological stress and the release of reactive metabolites with long-term complications in patients with diabetes mellitus. Accordingly, an experimental design will be undertaken with n=120 participants: 40 diabetic patients with complications, 40 without complications, and 40 healthy controls. Every participant will receive a thorough psychosomatic evaluation in the form of a questionnaire and the Structured Clinical Interview for DSM-IV (SCID). Stress levels and everyday stressors of the participants will be assessed using the Perceived Stress Scale (PSS), the Trier Inventory for the Assessment of Chronic Stress (TICS), and a Daily Stress Inventory (Alltagsbelastungsfragebogen, ABF). An experimental stress-provocation will be done in the form of the Trier Social Stress Tests (TSST). Both before and after the TSST, blood and saliva samples will be taken. The blood tests will be used to determine glucose, adrenalin, noradrenalin, and ACTH; as well as methylglyoxal and glyoxal and their glycation endproducts, and the total antioxidative capacity. In addition, the saliva tests will be used to measure cortisol activity.A prevalent hypothesis of this study is that the basal level of reactive metabolites is positively correlated with indicators of chronic stress (such as cortisol, heart rate, and subjective measurements). In addition, it is assumed that after acute stress episodes the dynamic change of reactive metabolites will be disturbed in a subgroup of diabetic patients. The central hypothesis is the assumption that the stress-induced dysbalance between production and decomposition of reactive metabolites will be more accentuated in patients with diabetic complications compared to those without complications. According to our understanding, this proposed project is the first three-group comparison design with repeated measurements, devised to examine the relationship between chronic stress, acute stress, methylglyoxal- and glyoxal- level (and changes), and diabetic complications. A close cooperation with the SFB 1118 'Reaktive Metabolite als Ursache diabetischer Folgeschäden' ('Reactive Metabolites as a Cause of Consequent Diabetic Complications') will be undertaken. In the context of a wider frame of reference, this study will serve as the basis for possible identification of the various stress-reactive patient groups that could benefit from stress-reduction therapy.