Association between stress and glycemic control in adult with type 1 (Insulin-dependent) diabetes

Department of Public Health, University of Birmingham, UK.
Diabetes Care (Impact Factor: 8.42). 08/1999; 22(8):1278-83. DOI: 10.2337/diacare.22.8.1278
Source: PubMed


To examine the relationship between stressful life events and alterations in glycemic control in adults with diabetes.
The occurrence of stressful experiences was recorded using the life Events and Difficulties Schedule of Brown and Harris in 55 adults with type 1 diabetes. The two most recent measures of glycemic control (HbA1c) were obtained from medical records, with poor glycemic control defined by the sample median (> or =7.7%).
Subjects whose control deteriorated over time or who remained in poor glycemic control were significantly more likely to report severe personal stressors (SPS) in the month before HbA1c measurement, compared with subjects whose control remained fair or whose control improved (43 and 25% vs. 7 and 0%; P = 0.000). Subjects whose control remained fair or whose control improved were significantly more likely to report only positive life events during the same time period (80 and 11% vs. 0 and 0%, respectively; P = 0.000). Multiple regression analysis demonstrated that SPS, sex, and lack of further education were all significantly associated with either remaining in poor control or deterioration of control.
The study has shown that recent severe stressors are associated with poorer glycemic control. Positive life events were associated with fair or improved glycemic control. This study has its limitations, and future studies should be prospective in design. While it is not always possible to avoid stress, learning to recognize and cope with stressors may help individuals with diabetes maintain good glycemic control and improve overall quality of life.

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    • "The optimal insulin dose for a given meal depends largely on the carbohydrate content and the insulin sensitivity (SI) of the patient, but many smaller and unquantified influences are also in effect, which can add significant complication to selfmanaged blood glucose (BG) control of the most diligent individuals. Stress, fatigue, and circadian metabolic rhythms are factors that modify the effective SI (Surwit et al., 1992, Räikkönen et al., 1996, Lloyd et al., 1999). Furthermore, exercise has a significant effect on the rate of glucose disappearance (Sonnenberg et al., 1990, Roy and Parker, 2007, Yardley et al., 2013). "
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    ABSTRACT: Prior research had been carried out to identify a large number of glycaemic variables in sparse, noisy data from a virtual diabetic patient. This paper investigates the precision of variables as an identification scheme introduces progressively more parameters into the variable set and as the quantity of data increases. Virtual data was simulated with a diabetic glycaemic meal model that contained six variable parameters. Data was sampled 6 times daily with noise. Increasing variable sets were identified for data subsets of increasing size. Norm-error of equivalent variable groups was compared before and after new parameter introductions. A Monte Carlo analysis was carried out to evaluate a population of results.
    Full-text · Article · Dec 2015
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    • "Experiencing life events is inherently stressful and thus can complicate any stress level already existing in an individual [69]. Lyod et al. [70] have noted that recent severe stressors were associated with poorer glycemic control while another study found a significant correlation between stress and HbA1c [71]. Hence, our findings of life events and elevated HbA1c levels being independently associated with stress symptoms are consistent. "
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    ABSTRACT: Background Diabetes mellitus is a highly prevalent condition in Malaysia, increasing from 11.6% in 2006 to 15.2% in 2011 among individuals 18 years and above. Co-morbid depression in diabetics is associated with hyperglycemia, diabetic complications and increased health care costs. The aims of this study are to determine the prevalence and predictors of depression, anxiety and stress symptoms in Type II diabetics attending government primary care facilities in the urban area of Klang Valley, Malaysia. Methods The study was cross sectional in design and carried out in 12 randomly selected primary care government clinics in the Klang Valley, Malaysia. A total of 2508 eligible consenting respondents participated in the study. The Depression, Anxiety and Stress Scale (DASS) 21 questionnaire was used to measure depression, anxiety and stress symptoms. Data was analyzed using the SPSS version 16 software using both descriptive and inferential statistics. Results The prevalence of depression, anxiety and stress symptoms among Type II diabetics were 11.5%, 30.5% and 12.5% respectively. Using multiple logistic regression, females, Asian Indians, marital status (never married, divorced/widowed/separated), a family history of psychiatric illness, less than 2 years duration of diabetes and current alcohol consumption were found to be significant predictors of depression. For anxiety, unemployment, housewives, HbA1c level of more than 8.5%, a family history of psychiatric illness, life events and lack of physical activity were independent risk factors. Stress was significantly associated with females, HbA1c level of more than 8.5%, presence of co-morbidity, a family history of psychiatric illness, life events and current alcohol consumption. For depression (adjusted OR 2.8, 95% CI 1.1; 7.0), anxiety (adjusted OR 2.4, 95% CI 1.1;5.5) and stress (adjusted OR 4.2, 95% CI 1.8; 9.8), a family history of psychiatric illness was the strongest predictor. Conclusion We found the prevalence of depression, anxiety and stress symptoms to be high among Type II diabetics, with almost a third being classified as anxious. Screening of high risk Type II diabetics for depression, anxiety and stress symptoms in the primary care setting is recommended at regular intervals.
    Full-text · Article · May 2013 · BMC Family Practice
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    • "The results also identified the IP stress group, which exhibited elevated perceived general diabetes-related stress, but membership was not associated with elevated mean HbA 1c . Given results of the previous literature indicate that elevated negative interpersonal stress is related to the deterioration of metabolic control in adults over time (Lloyd et al., 1999), it is important that researchers and clinicians examine these psychosocial variables in addition to metabolic outcomes. "
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    ABSTRACT: Given the inconsistent relationship between stress and metabolic control, the purpose of this study was to empirically derive patterns of perceived diabetes-related stress among youth with type 1 diabetes mellitus (T1DM) and determine if these patterns relate to overall diabetes-related stress levels and metabolic control. A sample of 204 youth with T1DM completed the diabetes stress questionnaire, and their hemoglobin A(1c) (a long-term measure of metabolic control) was obtained from their medical record. Latent profile analyses revealed three perceived-stress profiles: "low stress" (LS), "interpersonal/peer" (IP), and "family stress" (FS). The FS and IP groups reported more overall stress than the LS group; however, only the FS group's HbA(1c) values were significantly higher than either the LS or IP groups. A global measure of stress may not accurately account for the association between perceived stress and metabolic control. FS, rather than IP stress seems to be a key stress domain linked to suboptimal metabolic control.
    Full-text · Article · Jun 2012 · Journal of Pediatric Psychology
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