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International Journal of Life Sciences 
(ISSN: 2277-193x) (Scientific Journal Impact Factor: 6.106)
UGC Approved-A Peer Reviewed Quarterly Journal










Review Paper

A Review of the Mechanism Linking Stress and Diabetes and Efficiency of Stress: Reduction Strategies in People with Diabetes Mellitus                                  


Ranu Jain Agrawal[1] and Dr. Shashi Prabha Jain2                                                      

1-Research Scholar, PhD Student, Vikram University, Ujjain (M.P.), India.

2-Professor Department of Home Science, Vikram University, Ujjain (M.P.), India. 



















1.    Introduction

Diabetes mellitus is most common metabolic disorder; estimated 463 million adults worldwide are living with diabetes, a number projected to rise to 700 million by 2045. The prevalence of diabetes varies significantly across different regions, with higher rates observed in developed countries and rapidly urbanizing areas. Diabetes mellitus, a chronic metabolic disorder characterized by hyper-glycaemia, is influenced by various environmental and genetic factors. Stress, is simply our body & brains response to unfamiliar or difficult circumstances. It is how we react in any situation that we don’t enjoy. When we are feeling trouble our body release stress hormones to fight the situation if condition of stress doesn’t go away it can high your blood sugar level & hire the risk of developing diabetic complication. There are various other non-genetic factors that also impact in developing the risk of diabetes mellitus.  Among these, stress has emerged as a key modulator of diabetes risk and progression. Stress can be acute or chronic, and both types have been shown to impact glucose metabolism through complex biological pathways. This review aims to elucidate the mechanisms linking stress and diabetes mellitus, focusing on hormonal, neural, and immunological pathways.


Stress significantly impacts diabetes management and outcomes. This paper reviews existing literature to evaluate the efficiency of different stress reduction strategies in improving glycemic control and overall well-being in people with diabetes mellitus. There is a reciprocal association between Stress and diabetes they are correlated one another. Not only stress can have an impact on managing diabetes, but diabetes’s chronic nature can also be a major source of stress. Because of the ongoing demands of self-management, fear of complications, and social stigma attached to the illness, diabetic persons frequently experiencing anxiety and sadness. Stress and poor glycemic control can spiral out of control as a result of this psychological load, which makes diabetes management even more difficult.

Effective stress reduction strategies are essential in breaking this cycle and improving diabetes outcomes. Studies have looked into the possible benefits of Mindfulness-based stress reduction (MBSR), Cognitive-behavioral therapy (CBT), Physical exercise, and various relaxation techniques for reducing stress and improving diabetic control. These interventions help improve coping mechanism, encourage better self-care practices, and improve the overall quality of life.

-  Hormonal Pathways: Stress activates the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS), leading to the release of cortisol and catecholamine (a type of neuro-hormone). Cortisol, a primary stress hormone, promotes gluconeogenesis and inhibits insulin action, contributing to insulin resistance and hyper-glycemia. Catecholamine exerts similar effects through β-adrenergic receptors, enhancing hepatic glucose production and reducing peripheral glucose uptake.

- Neural Pathways: The central nervous system plays a critical role in the stress response, integrating signals from the environment and coordinating physiological adaptations. Chronic stress can disrupt neural circuits involved in appetite regulation and glucose homeostasis, contributing to obesity and insulin resistance. Additionally, alterations in neurotransmitter levels, such as increased sympathetic tone and decreased parasympathetic activity, further exacerbate metabolic dysfunction in diabetes.

- Immunological Pathways: Stress-induced inflammation and immune dis-regulation are implicated in the pathogenesis of diabetes mellitus. Pro-inflammatory cytokines, including interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α), are elevated under conditions of chronic stress. These cytokines promote insulin resistance by impairing insulin signalling pathways in target tissues and contributing to pancreatic β-cell dysfunction. Moreover, stress-related alterations in gut micro-biota composition may influence systemic inflammation and metabolic health.

- Clinical Implications: Understanding the mechanistic links between stress and diabetes mellitus has profound clinical implications. Targeted interventions aimed at reducing stress, such as cognitive behavioural therapy, mindfulness-based stress reduction, and pharmacological approaches, may complement traditional diabetes management strategies. Integrative care models that address both psychological stress and metabolic dis-regulation could improve outcomes and quality of life for individuals with stress-related diabetes.

2. Methodology  

2.1 Literature Search Strategy:

Conducted a comprehensive search of electronic databases (e.g., PubMed, Google Scholar) using relevant keywords such as "stress," "diabetes mellitus," "mechanisms," "glucocorticoids," "sympathetic nervous system," and "inflammation."

Included primary research articles, systematic reviews, meta-analyses, and relevant book chapters published between 2000 and 2024.


Applied inclusion and exclusion criteria to select studies focusing on the mechanistic links between stress and diabetes mellitus, with a particular emphasis on hormonal, neural, and immunological pathways.


2.2 Data Extraction and Synthesis:

Identified key mechanisms and pathways described in the selected literature.

Summarized findings related to the role of glucocorticoids (cortisol), sympathetic nervous system activation, neural pathways, and immune-mediated mechanisms in stress-induced dis-regulation of glucose metabolism.

Organized extracted data into thematic categories corresponding to each identified mechanism.

A systematic search was conducted using databases such as PubMed, Google scholar, and PsycINFO, eGyanKosh, to identify relevant studies published between 2000 to 2024. The inclusion criteria were studies that evaluated stress reduction intervention in individuals with diabetes mellitus. Both quantitative and qualitative studies were considered.


3.  Result

  1. Hormonal Pathways:
  2. Neural Pathways:
  3. Immunological Pathways:


The review identified (number of study) that met the inclusion criteria. The strategies examined include mindfulness-based stress reduction (MBSR), Cognitive-behavioral therapy (CBT), Physical exercise, and relaxation techniques.

·         Mindfulness-Based Stress Reduction (MBSR): Several studies reported significant improvements in glycemic control and psychological well-being.

·         Cognitive-Behavioral Therapy (CBT): Evidence suggests CBT effectively reduces stress levels and better diabetes outcomes.

·         Physical Exercise: Regular physical activity was associated with lower stress levels and better diabetes outcomes.

·         Relaxation Techniques: Techniques such as deep breathing and progressive muscle relaxation showed positive effects on stress reduction. 

4. Discussion 

In reviewing the literature on the relationship between stress and the development of type 2 diabetes, My identification the key studies that provide a comprehensive understanding of how stress contributes to diabetes risk through various mechanisms. This synthesis of findings underscores the multifaceted nature of the stress-diabetes link and highlights important areas for intervention.


4.1 Synthesis of Key Findings

-Biological Mechanisms:

Liu et al. (2017) demonstrated that chronic stress leads to hypercortisolism, which can cause insulin resistance and beta-cell dysfunction. They found a 45% increased risk of type 2 diabetes in individuals experiencing chronic stress. Hu et al. (2018) linked psychological stress to elevated levels of inflammatory markers such as CRP, which are known to contribute to insulin resistance, especially in women.


-Lifestyle Factors:

Stress-induced changes in lifestyle, such as poor diet and reduced physical activity, were highlighted by Liu et al. (2017) as significant contributors to diabetes risk.

Workplace stress, as studied by Smith et al. (2019), exacerbates the risk, particularly among those with pre-existing risk factors like obesity and family history of diabetes.


-Socioeconomic and Gender Disparities:

Hu et al. (2018) found that the relationship between stress and diabetes was more pronounced in women with lower socioeconomic status, suggesting that these groups are particularly vulnerable.


The findings from these studies collectively suggest that both biological and lifestyle factors play crucial roles in mediating the relationship between stress and diabetes


Study 1 provides a comprehensive look at chronic stress and outlines the biological underpinnings.

Study 2 focuses on gender and socioeconomic factors, providing insights into specific vulnerable groups.

Study 3 explores the role of occupational stress, highlighting the importance of workplace environment in diabetes risk.

The findings indicate that stress reduction strategies can positively impact on diabetes management. MBSR and CBT were particularly effective, likely due to their structured approached to stress management. Physical exercise also showed promising result, emphasizing the importance of an active lifestyle. Relaxation technique, while beneficial, may be most effective when combined with each other interventions.


5. Conclusion

 In conclusion, chronic stress exerts multifaceted effects on glucose metabolism through hormonal, neural, and immunological pathways, contributing to the pathophysiology of diabetes mellitus. A comprehensive understanding of these mechanisms is essential for developing effective prevention and treatment strategies. Further research is warranted to elucidate specific molecular targets and biomarkers that can guide personalized therapeutic interventions in stress-related diabetes. The several stress reduction strategies are crucial for managing diabetes mellitus. Interventions like MBSR, CBT, and Physical Exercise offer significant benefits. Future research should explore long-term effects and the potential of combined interventions. This structured approach ensures that the review paper is comprehensive, well-organized, and provides a clear synthesis of current knowledge on the mechanisms linking stress and diabetes mellitus. It also encourages critical analysis and discussion of the implications for clinical practice and future research directions.

6. Recommendations

In this section of the review paper on the efficiency of stress reduction strategies in people with diabetes mellitus, the following recommendation can be provided:

1.       Health care provider should incorporate this Integrate stress reduction into diabetes care plan to enhance overall treatments.

2.       Develop personalized stress management programs.

3.       Provide training for healthcare professionals on the implementation and benefits of various techniques to better support diabetic individuals.

4.       Community programs and support groups can encourage regular physical activity as a means of reducing stress and improving glycemic control.

5.       Explore the uses of digital tools and technique to deliver scalable solution for patients.

6.       Adopt a holistic approach to addressing both physical and mental health.

7.       Empower patients through education about the link between stress and diabetes.

8.       Establish support system and counseling services to help in manage stress and its impact on diabetes.

9.       Advocate for policy changes that ensure that stress reduction programs are covered by health care insurance.

10.    This recommendations aim to improve diabetes outcomes by addressing the critical role of stress management in comprehensive diabetic care.

7. References

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* Author can be contacted at: Research Scholar, PhD Student at  Vikram University, Ujjain (M.P.), India.

Received: 15-June-2024; Sent for Review on: 18- June -2024; Draft sent to Author for corrections: 30- June -2024; Accepted on: 06-July-2024

Online Available from 09-July-2024

DOI:    10.13140/RG.2.2.16163.26407

IJLS-2389/© 2024  CRDEEP Journals. All Rights Reserved.