Related Experiment Video
Updated: Apr 24, 2026

Collecting Saliva and Measuring Salivary Cortisol and Alpha-amylase in Frail Community Residing Older Adults via Family Caregivers
Published on: December 18, 2013
Association of diurnal patterns in salivary cortisol with type 2 diabetes in the Whitehall II study
Ruth A Hackett1, Andrew Steptoe, Meena Kumari
1Department of Epidemiology and Public Health (R.A.H., A.S.), University College London, London WC1E 6BT, United Kingdom; and Institute for Social and Economic Research (M.K.), University of Essex, Colchester CO4 3SQ, United Kingdom.
Context:
The hypothalamic pituitary-adrenal axis is thought to play a role in Type 2 Diabetes (T2D). However, the evidence for an association between diurnal cortisol patterns and T2D is equivocal.
Objective:
The aim was to examine the association of cortisol patterns throughout the day with T2D status in a community-dwelling population.
Design:
This was a cross-sectional study of T2D status and salivary cortisol from phase 7 (2002-2004) of the Whitehall II study, United Kingdom.
Setting:
The occupational cohort was originally recruited in 1985-1988.
Participants:
Three-thousand, five-hundred eight white men and women including 238 participants with T2D aged 50-74 years with complete information on cortisol secretion participated.
Outcome Measures:
We measured diurnal cortisol (nmol/L) patterns from six saliva samples obtained over the course of a normal day: at waking, +30 min, +2.5, +8, +12 hours, and bedtime. The cortisol awakening response and slope in diurnal secretion were calculated.
Results:
T2D status was associated with a flatter slope in cortisol decline across the day (b = 0.004; confidence interval [CI], 0.001-0.007; P = .014) and greater bedtime cortisol (b = 0.063; CI, 0.010-0.117; P = 0.020) independent of a wide range of covariates measured at the time of cortisol assessment. There was no association between morning cortisol, the cortisol awakening response, and T2D (P > .05).
Conclusions:
In this nonclinical population, T2D was associated with a flatter slope in cortisol levels across the day and raised bedtime cortisol values.
Related Concept Videos
Type II Diabetes I: Introduction
Type II Diabetes II: Pathophysiology
Type II Diabetes Mellitus III: Clinical Manifestations and Diagnosis
Type I Diabetes III: Clinical Manifestations
Psychoneuroimmunology: Diabetes and Cancer
Type I Diabetes II: Pathophysiology

