Increased insulin secretion and decreased glucose concentrations, but not allostatic load, are associated with stress-related exhaustion in a clinical patient population

Abstract

Allostatic load (AL) has been shown to be a useful marker of physiological strain during chronic stress and burnout in non-clinical working populations. The usability of the AL index for a clinical population with severe stress-related exhaustion was tested in this study. Thirteen biomarkers assembled as an AL index were analysed using blood samples from 90 patients with stress-related exhaustion (43 men and 47 women, age 31–61 years) and 90 healthy controls (46 men and 44 women, age 25–56 years). The AL scores did not differ between patients and controls. For men, some indication of higher cardiovascular risk was seen in the patient group: male patients had higher body mass index and waist–hip ratio and a poorer blood lipid status than male controls. We found lower plasma glucose concentrations in both female and male patients than those in controls. The male patients also showed increased fasting serum insulin concentrations. Further analysis using homeostasis model assessment for insulin resistance and β-cell function showed indications of insulin resistance in the patient group, particularly in the males, and an increased insulin secretion in both male and female patients. In conclusion, AL index does not seem to capture plausible physiological strain in patients diagnosed with stress-related exhaustion. The finding of lower plasma glucose concentrations, probably due to higher insulin secretion, in patients with severe stress-related exhaustion, needs to be further investigated, including mechanisms and the clinical relevance.

Keywords::

• Allostatic load
• β-cell function
• burnout
• glucose
• insulin resistance
• stress-related exhaustion

Acknowledgements

We gratefully acknowledge the valuable help of Karin Nygren, Marie-Louise Norberg and Anna Palmgren for conducting the blood sampling and supervising the inclusion procedures. We also thank Emina Hadzibajramovic for statistical guidance. This study was supported by a grant from the Swedish government.

Declaration of interest : The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. JWE is employed at AstraZeneca.