Combined Use of Job Stress Models and the Incidence of Glycemic Alterations (Prediabetes and Diabetes): Results from ELSA-Brasil Study

Abstract

Evidence of psychosocial stress at work as a risk factor for diabetes and prediabetes is restricted. Objectives: Analyze the independent and combined association of the models, demand–control and social support (DC-SS) and the effort–reward imbalance and overcommitment (ERI-OC), and the incidence of glycemic alterations (prediabetes and diabetes). Methods: A prospective study was carried out with data from 7503 active workers from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) study in the period 2008–2014. Work stress was measured by two stress models. Glycemic levels were evaluated by glycated hemoglobin (HbA1c) in two moments and classified in four groups: normal, maintenance of prediabetes, incident prediabetes, and incident diabetes. Multinomial logistic regression was analyzed with 5% significance levels stratified by sex, and multiplicative interactions were investigated. Results: Work stress and glycemic alterations were more frequent in women. Psychosocial stress at work was shown to be associated to the risk of prediabetes and diabetes only among women. For women, the combination of models enlarged the magnitude of the association: prediabetes (DC-ERI = OR 1.51, 95% CI 1.15–1.99) and diabetes (DC-ERI = OR 2.10, 95% CI 1.20–3.65). Highly-educated women exposed to ERI-OC were four times more likely to have diabetes. Conclusion: Both models may contribute to explaining the psychosocial stress load according to each pattern of glycemic alteration among women.