Psychoneuroimmunological Aspect of Type 2 Diabetes Mellitus
Diabetes is a chronic disease which included in the 10 major leading causes of death globally. Pathogenesis of DM 2 involves complex mechanisms in various organs. Psychological conditions including stress, anxiety, and depression considered to be reciprocally related to impaired glucose regulation. On the other hand, hyperglycaemia in DM 2 may triggers some psychological disorder. Chronic psychological disorders activate the HPA axis, causing cortisol level elevation and disrupt its negative feedback mechanism. Other factors involved in disturbance of glucose regulation due to psychological distress were sympathetic nervous system, inflammatory and oxidative stress pathways, tryptophan metabolism and gut microbiota dysbiosis. These factors were interrelated to form a vicious cycle causing progression and complications in DM 2.