Youth Stuttering Tied to Early Onset Type 2 Diabetes in Males

Miriam E. Tucker

January 26, 2021

Young men who stutter may be at increased risk for early onset type 2 diabetes, new data suggest.

The findings, from a unique analysis of data from Israeli youth evaluated for military service, were published online January 15 in the Journal of Clinical Endocrinology and Metabolism by Avishai M. Tsur, MD, of the Israeli Defense Forces Medical Corp, Ramat Gan, Israel, and colleagues.

Among more than 4000 males aged 16-20, those who stuttered had a 30% greater risk for developing type 2 diabetes overall and more than double the risk for developing type 2 diabetes prior to age 40 years compared with those who didn't stutter.

The risk was independent of body mass index (BMI), comorbidities, and socioeconomic status. The same association wasn't found among females, but stuttering is four times more common among men than women, the authors note.  

"The main clinical takeaway is that stuttering is a medical condition that requires careful risk stratification and mitigation of concomitant diabetes risk factors. This is of special importance since people with stuttering tend to avoid medical encounters," senior author Gilad Twig, MD, PhD, associate professor in medicine at the Hebrew University of Jerusalem, told Medscape Medical News.

Is it Stress?

One plausible mechanism is social anxiety leads to high cortisol levels, the authors say, noting: "Chronic stress and increased secretion of cortisol could increase the risk for type 2 diabetes independently from obesity."

Other possible explanations include dysregulation of brain dopamine metabolism — which has been linked to both stuttering and type 2 diabetes — altered cerebral blood flow leading to impairment of glucose sensing neuronal networks in the hypothalamus, and certain structural abnormalities in the brain that appear in both stuttering and type 2 diabetes.

Regardless, Twig says, "Our results highlight the importance of reduction of other modifiable risk factors for diabetes, especially obesity, and the importance to adopt a healthy lifestyle. We also think that people with stuttering may deserve a tighter follow-up, but additional studies are needed to confirm this."

Stuttering Linked to Type 2 Diabetes Even After Adjustments

The study population was drawn from a total of 1,224,494 males and 889,311 females evaluated for military service eligibility in Israel at ages 16-20 years from 1980 through 2013. Of those, there were 4443 men and 503 women with stuttering.

Among the men, incident cases of type 2 diabetes developed in 3.6% with stuttering versus 2.1% without. The odds ratio (OR) was a significant 1.32 after adjustments for age, year, BMI, country of birth, socioeconomic status, cognitive performance, education, presence of chronic comorbidities, and presence of psychiatric comorbidities.

The association persisted when the analysis was conducted only among those who did not have chronic medical or psychiatric comorbidities.

The results remained significant among men with stuttering with a BMI < 85th percentile (OR, 1.23) or ≥ 85th percentile (OR 1.48), those with high versus low cognitive performance (OR, 1.29 and 1.37, respectively), and low versus high socioeconomic status.

The association was also evident when nonstuttering brothers of males who stuttered were used for comparison (OR, 1.49).

And the risk of diabetes associated with stuttering was higher among those born more recently, with an adjusted OR of 2.37 for those born from 1980 onward (who were aged 36 years or younger by the end of the study period) compared with 1.21 for those born in the 1960s.

In a separate analysis of the 2289 men with stuttering who entered the study in 1996 onward, incident type 2 diabetes occurred in 0.87% with stuttering versus 0.29% without after 15 years of follow-up, when the men were aged 31-35 years, for an adjusted OR of 2.32.

In females, incident type 2 diabetes occurred in 1.4% with and 1.1% without stuttering during the study period. The difference was not significant, with an adjusted OR of 1.03.

Twig told Medscape Medical News that his team is conducting more work in this area.

"For early onset type 2 diabetes, we have several ongoing studies that opt to characterize other risk factors for incident diabetes, some of them already published and some about to be published. For stuttering, we plan to assess potential association with other cardiometabolic morbidity," he said.

There was no funding for this study. The authors have reported no relevant financial relationships.

J Clin Endocrinol Metab. Published online January 15, 2021. Abstract

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