Stress and Blood Glucose Control

STRESS AND BLOOD GLUCOSE CONTROL

Psychological stress has significant effects on the metabolism on individuals without diabetes by increasing counterregulatory hormones, which could result in elevated blood sugars, among other impacts.

In type 2 diabetes it is thought that stress can exert an effect on blood glucose control, either directly through these hormones or indirectly by disruption of the diabetes self-care regimen.

Although the laboratory and clinical research to date does not appear to support a consistent stress-blood glucose response across all patients, there is evidence that some individuals with diabetes are "stress responders" (43). Individuals with type 1 diabetes may have idiosyncratic responses to stress, with some showing increases in blood glucose levels and others decreases. However, for type 2 diabetes the effects of stress are more likely to result in increases in blood glucose, secondary to sympathetic activity (43,44).

Evidence from animal models also suggests a role for stress in the onset of type 2 diabetes (45).

Ineffective coping (e.g., avoidance, denial, detachment, anger) has been shown to be associated with poorer metabolic control in diabetes and adaptive coping (e.g., active problem solving and ability to obtain social support) with a stress-buffering role (46), highlighting the role of patient perceptions of stressful events. It is unclear whether relaxation training (e.g., biofeedback) produces glycemic benefits in type 2 diabetes (47).

Generally, there is a paucity of studies on stress in type 2 diabetes.

PSYCHIATRIC ILLNESSES

Patients with diabetes have elevated levels of psychiatric illnesses compared with the general population and similar to those found in other chronic illnesses.

The most common psychiatric disorder in type 2 diabetes is major depression, while other significant disorders include anxiety disorders, alcohol and substance use disorders, and eating disorders, principally binge-eating syndrome (28,48 - 51).

Lifetime prevalence of recent (i.e., within 6 months) psychiatric disorders among individuals with chronic illnesses, such as cancer, arthritis, and heart disease, has been found to be 40%, which is higher than for those without such illnesses (52).

A number of studies have been conducted recently to estimate psychiatric illnesses in type 2 diabetes. This section concentrates on major depression, but also discusses briefly anxiety disorders, alcohol abuse and dependence, and binge-eating disorder (BED), which are commonly associated with obesity.