Stress Management Can Help Control Glucose In Type 2 Diabetes

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 cont