Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. May 15, 2015; 6(4): 554-565
Published online May 15, 2015. doi: 10.4239/wjd.v6.i4.554
Toxic stress, inflammation and symptomatology of chronic complications in diabetes
Charles A Downs, Melissa Spezia Faulkner
Charles A Downs, Melissa Spezia Faulkner, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States
Author contributions: Downs CA and Faulkner MS contributed equally to the conceptualization, development, writing and final review of this paper.
Conflict-of-interest: There are no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Melissa Spezia Faulkner, PhD, RN, FAAN, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Suite 244, Atlanta, GA 30322, United States. melissa.faulkner@emory.edu
Telephone: +1-404-7129693 Fax: +1-404-7274645
Received: August 28, 2014
Peer-review started: August 28, 2014
First decision: December 17, 2014
Revised: December 30, 2014
Accepted: February 10, 2015
Article in press: February 12, 2015
Published online: May 15, 2015
Abstract

Diabetes affects at least 382 million people worldwide and the incidence is expected to reach 592 million by 2035. The incidence of diabetes in youth is skyrocketing as evidenced by a 21% increase in type 1 diabetes and a 30.5% increase in type 2 diabetes in the United States between 2001 and 2009. The effects of toxic stress, the culmination of biological and environmental interactions, on the development of diabetes complications is gaining attention. Stress impacts the hypothalamus-pituitary-adrenal axis and contributes to inflammation, a key biological contributor to the pathogenesis of diabetes and its associated complications. This review provides an overview of common diabetic complications such as neuropathy, cognitive decline, depression, nephropathy and cardiovascular disease. The review also provides a discussion of the role of inflammation and stress in the development and progression of chronic complications of diabetes, associated symptomatology and importance of early identification of symptoms of depression, fatigue, exercise intolerance and pain.

Keywords: Toxic stress, Type 1 diabetes, Inflammation, Type 2 diabetes, Chronic complications, Symptomatology

Core tip: The incidence of diabetes and associated complications are increasing. Toxic stress and inflammation may be contributors to the development and progression of diabetes complications. Current evidence supports early identification of symptoms of toxic stress for preventative strategies of associated risks for diabetes complications as well as assessment of the exacerbation of symptoms related to neuropathy, cardiovascular disease and nephropathy.