:: Stress Management Can Help Control
Glucose in Type Two Diabetes
DURHAM, N.C., Dec. 27
(AScribe News) -- Patients with type 2 diabetes
who incorporate stress management techniques into their routine care
can significantly reduce their average blood glucose levels, according
to a new study by researchers at Duke University Medical Center.
This
is the first large study to show that a simple, cost-effective treatment
can have a meaningful therapeutic effect on the control of blood sugar,
said the researchers. Such stress management techniques include instructions
on how to identify everyday life stressors and how to respond to them
with such techniques as progressive muscle relaxation and breathing
exercises.
Stress
can increase glucose levels in people with diabetes, making them more
susceptible to long-term physical complications such as eye, kidney
or nerve disorders
Results
of the study are published in the January 2002 issue of the journal
Diabetes Care.
"The
stress management techniques, when added to standard care, helped reduce
glucose levels," said Richard Surwit, lead author of the study and a
medical psychologist at Duke. "The change is nearly as large as you
would expect to see from some diabetes-control drugs."
Patients
in the stress management group showed, on average, a 0.5 percent reduction
on the hemoglobin A1c (HbA1c) test ? a standard laboratory test used
to determine average blood glucose levels in people with diabetes. However,
32 percent of the patients in that group showed an even greater improvement
by lowering their glucose level by 1 percent or more.
According
to Surwit, that amount of glucose level reduction is what the Food and
Drug Administration (FDA) considers sufficient when reviewing drugs
seeking approval for diabetes control.
A
total of 108 patients with type 2, also known as adult-onset, diabetes
participated in five 30-minute educational sessions about diabetes.
The basic program focused on general facts (such as signs or symptoms
of the disease), complications (such as foot, eye and dental issues),
healthy eating and treatment information. There were no discussions
of specific recommendations or glycemic goals.
The
patients were randomly enrolled in the educational sessions either with
or without stress management training. Stress-management techniques
were taught by nurses or graduate students specifically trained for
the study. The training included progressive muscle relaxation, mental
imagery, breathing techniques and instructions on how to modify one's
physiologic, cognitive and behavioral responses to stress.
At
the beginning of the study, and at subsequent times throughout the year-long
tracking period, patients were tested using the HbA1c test to evaluate
their blood sugar control and with various questionnaires to assess
their trait anxiety. Such trait anxiety included perceived levels of
stress, anxiety and psychological health. All participants were at least
30 years old and currently managing their diabetes with diet, exercise
and/or non-insulin medications.
"Patients
with type 2 diabetes might be at increased health risk from the effects
of stress," Surwit said. "Experiencing stress is associated with the
release of hormones that lead to energy mobilization ? known as the
'fight or flight' response. Key to this energy mobilization is the transport
of glucose into the bloodstream, resulting in elevated glucose levels,
which is a health threat for people with diabetes."
Stress
also can disrupt diabetes control indirectly through its effects on
diet and exercise, he said.
After
six months, the control group began to show deterioration in their glucose
levels, while the stress management group continued to improve. By the
end of one year, 32 percent of the patients randomized to stress management
had HbA1c levels that were lower by 1 percent or more. In contrast,
only 12 percent of the control subjects had levels that were this much
lower. According to Surwit, the effect cannot be explained by changes
in body mass index, diet or exercise because the two groups did not
differ on these variables during the year they were followed.
The
HbA1c test has been shown to be effective in predicting coronary disease
and other risks to people with diabetes, including the development of
microvascular complications in the kidneys or eyes, noted Surwit.
"Managing
stress can significantly improve a patient's control of their diabetes,"
said Surwit. "These techniques are simple, quick to learn, and have
been shown to work for multiple conditions, including coronary syndromes.
There are many self-help books and other commercially available materials
about stress management from which patients can learn these techniques."
According
to Surwit, future studies may look at whether or not a strictly self-help
approach to stress management can be equally as effective as the group-based
educational intervention tested in this study.
The study was supported by grants from the National Institute of Diabetes
& Digestive & Kidney Diseases and the National Institutes of Health.
Other
authors on the study include: Dr. Mark Feinglos, Miranda Van Tilburg,
Nancy Zucker, Cynthia C. McCaskill, Priti Parekh, Christopher L. Edwards,
Paula Williams and James D. Lane, all of Duke University Medical Center.
Courtesy : American Diabetes Association
