Effect of acute psychotic stress in nondiabetic subjects on β-cell function and insulin sensitivity

OBJECTIVE - To determine the effect of acute psychotic stress on glucose homeostasis in nondiabetic subjects. RESEARCH DESIGN AND METHODS - β-Cell function and insulin sensitivity were determined by the homeostasis model assessment in 39 nondiabetic patients with acute psychotic stress reaction admitted to a psychiatric ward. The clinical global impression (CGI) score was used to evaluate the level of psychological stress. Patients were assessed on admission, after 2 weeks, before discharge, and 6 months after discharge. RESULTS - The mean CGI score decreased significantly with time: 5.3 ± 0.8 and 1.6 ± 0.7 on admission and predischarge, respectively (P < 0.001). This was associated with a significant reciprocal increase of mean β-cell function from 96.8 ± 33.2 to 134.4 ± 60% at admission and postdischarge, respectively (P < 0.003), and a decrease of mean insulin sensitivity from 101.7 ± 36 to 77.1 ± 34.8% (P < 0.001). In contrast, mean glucose and HbA_1c levels did not change significantly. Subgroup analysis demonstrated that patients with the highest stress score on admission (≥6) had significantly higher glucose (P = 0.01) and insulin levels (P = 0.04) than patients with lower score (<6). Furthermore, insulin sensitivity and CGI score on admission were inversely correlated (r = -0.38, P < 0.02). In these patients, no correlation was found between β-cell function or insulin sensitivity and BMI. CONCLUSIONS - These data indicate that β-cell function and insulin sensitivity are inversely correlated with acute psychotic stress.