FINANCIAL stress may be associated with an increased risk of developing pre-diabetes and Type 2 diabetes (T2D), according to findings from a large prospective cohort study involving more than 150,000 adults.
Researchers found that specific stress-related experiences, particularly financial difficulties, were associated with increased diabetes risk, while cumulative measures of chronic and acute stress demonstrated weaker relationships. The findings suggest that the contribution of stress to metabolic health may be closely linked to socioeconomic circumstances and lifestyle factors.
Chronic and acute stress have been investigated as potential contributors to metabolic disease, but the extent to which different stressors influence the development of pre-diabetes and T2D remains uncertain.
To explore these relationships, researchers analysed data from the population-based Lifelines cohort study in the Netherlands.
The analysis included 152,861 adults without diabetes at baseline, with initial assessments conducted between 2006 and 2013 and follow-up between 2014 and 2018.
Chronic stress was assessed using the Life Difficulties Inventory (LDI), while acute stress was measured using the List of Threatening Experiences (LTE). Stress exposures were assessed at baseline and follow-up, allowing researchers to account for changes over time.
The study examined the development of pre-diabetes and T2D using blood glucose measurements, glycated haemoglobin (HbA1c), and self-reported diabetes diagnoses.
Researchers also adjusted their analyses for demographic, socioeconomic, and lifestyle characteristics to investigate whether associations persisted after accounting for these factors.
During follow-up, 7,499 participants developed pre-diabetes, while 3,127 developed T2D.
Overall, cumulative stress scores demonstrated limited associations with either outcome after adjustment for lifestyle factors.
The total LDI score was modestly associated with T2D risk, with a hazard ratio (HR) of 1.03 (95% CI 1.01–1.04), but showed no significant association with pre-diabetes.
However, analyses of individual stress domains revealed stronger relationships.
Moderate financial strain was associated with a 17% higher risk of pre-diabetes (HR 1.17; 95% CI 1.10–1.25) and a 28% higher risk of T2D (HR 1.28; 95% CI 1.17–1.41).
Major financial crises, assessed through the LTE, were also associated with increased risks of both conditions.
Other stressors demonstrated more selective relationships. Restricted free time was associated with pre-diabetes, while health-related stress was associated with T2D.
These findings indicate that the type of stress experienced may be more relevant to diabetes risk than overall stress burden.
To better understand the relationships between stress and metabolic health, researchers conducted exploratory network analyses examining how different stress domains clustered with socioeconomic and lifestyle characteristics.
The analyses identified connections between stress-related experiences and socioeconomic factors, particularly household income and marital status, alongside relationships with behavioural factors.
These findings suggest that stress may contribute to diabetes risk through interconnected social and lifestyle pathways rather than functioning as a strong independent risk factor.
Financial difficulties, for example, may coexist with circumstances that influence health behaviours and metabolic outcomes, although the study did not establish specific causal mechanisms.
The researchers emphasised that the observed associations were generally modest and varied considerably between stress domains.
Furthermore, the observational design means that the findings cannot establish whether stress directly causes pre-diabetes or T2D.
The findings highlight the potential importance of considering socioeconomic circumstances and specific sources of stress when evaluating diabetes risk.
Rather than focusing exclusively on overall stress levels, the researchers suggested that identifying particular stress-related difficulties, especially financial strain, may provide additional insight into metabolic health inequalities.
The study also reinforces the complexity of diabetes development, with stress-related exposures interacting with broader social and lifestyle factors.
The researchers concluded that stress showed modest, domain-specific associations with incident pre-diabetes and T2D, supporting further investigation into how social circumstances and behavioural pathways contribute to diabetes risk.
Reference
Liu S, Corpeleijn E, Habibovic M, Soedamah-Muthu SS. Association between stress-related exposures and risk of pre-diabetes and type 2 diabetes: results from the population-based Lifelines cohort study. BMJ Open Diabetes Research & Care. 2026;14:e006219. https://doi.org/10.1136/bmjdrc-2026-006219
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