Stress management improves long-term glycemic control in type 2 diabetes.
OBJECTIVE
There is conflicting evidence regarding the utility of stress management training in the treatment of diabetes. The few studies that have shown a therapeutic effect of stress management have used time-intensive individual therapy. Unfortunately, widespread use of such interventions is not practical. The aim of the present investigation is to determine whether a cost-effective, group-based stress management training program can improve glucose metabolism in patients with type 2 diabetes and to determine whether a particular subset of patients is more likely to get positive results.


METHODS
Patients with type 2 diabetes were randomized to undergo a five-session group diabetes education program with or without stress management training. Participants (n = 108) were followed for 1 year, during which HbA(1c) tests and questionnaires assessing perceived stress, anxiety, and psychological health were administered at regular intervals to evaluate treatment effects.


RESULTS
Stress management training was associated with a small (0.5%) but significant reduction in HbA(1c). Compliance with the treatment regimen decreased over time but was similar to that seen in patients receiving stress management for other reasons in the clinic. Trait anxiety (a measure of stable individual differences in anxiety proneness) did not predict response to treatment, showing that highly anxious patients did not derive more benefit from training.


CONCLUSIONS
The current results indicate that a cost-effective, group stress management program in a "real-world" setting can result in clinically significant benefits for patients with type 2 diabetes.
Surwit
Richard S
RS
Duke University Medical Center, Durham, North Carolina 27710, USA. richard.surwit@duke.edu
van Tilburg
Miranda A L
MA
Zucker
Nancy
N
McCaskill
Cynthia C
CC
Parekh
Priti
P
Feinglos
Mark N
MN
Edwards
Christopher L
CL
Williams
Paula
P
Lane
James D
JD
D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000523:psychology* / Q000534:rehabilitation; D002149:Energy Intake; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008347:Manifest Anxiety Scale; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D010555:Personality Inventory; D044469:Racial Groups; D013315:Stress, Psychological / Q000517:prevention & control*; D011795:Surveys and Questionnaires
D001786:Blood Glucose; D006442:Glycated Hemoglobin