Abstract
OBJECTIVE
Although there is scientific evidence that stress adversely affects metabolic control, only a few studies have examined the role of stress management in improving glycemic control in patients with type 2 diabetes mellitus (DM). In this study, we investigated the effect of a relaxation technique on levels of stress and glycemic control.
DESIGN
A total of 53 patients with type 2 DM were randomly assigned to undergo either an 8-week stress management program, consisting of 10 min of diaphragmatic breathing and 15 min of progressive muscle relaxation twice per day (n=25, intervention group), or not (n = 28, control group). Perceived stress, health locus of control and HbA1c were primary outcomes and were measured before and after intervention.
RESULTS
In the intervention group, perceived stress score (PSS) and HbA1c had decreased significantly (P<0.05) by the end of the program. Specifically concerning the PSS, the higher the initial levels of perceived stress the greater the benefit of the intervention. No other significant changes were found.
CONCLUSIONS
Our results show a beneficial role of stress management for patients with type 2 DM, as regards both stress levels and glycemic control. It is recommended to consider this type of treatment as an adjunct to conventional therapy. We deem that our study could encourage future studies in this area with larger samples, longer duration and more objective measurements.
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References
The InterAct Consortium, 2012 Physical activity reduces the risk of incident type 2 diabetes in general and in abdominally lean and obese men and women: the EPIC-InterAct Study. Diabetologia 55: 1944–1952.
Kohrt WM, Kirwan JP, Staten MA, Bourey RE, King DS, Holloszy JO, 1993 Insulin resistance in aging is related to abdominal obesity. Diabetes 42: 273–281.
Ohlson LO, Larsson B, Svardsudd K, et al, 1985 The influence of body fat distribution on the incidence of diabetes mellitus. 13.5 years of follow-up of the participants in the study of men born in 1913. Diabetes 34: 1055–1058.
Wellen KE, Hotamisligil GS, 2005 Inflammation, stress, and diabetes. J Clin Invest 115: 1111–1119.
Friedman TC, Mastorakos G, Newman TD, et al, 1996 Carbohydrate and lipid metabolism in endogenous hypercortisolism: shared features with metabolic syndrome X and NIDDM. Endocr J 43: 645–655.
Kyrou I, Chrousos GP, Tsigos C, 2006 Stress, visceral obesity, and metabolic complications. Ann N Y Acad Sci 1083: 77–110.
Kyrou I, Tsigos C, 2007 Stress mechanisms and metabolic complications. Horm Metab Res 39: 430–438.
Henry J, Jane L, Wilson PH, Bruce DG, Chisholm DJ, Rawling DJ, 1997 Cognitive-behavioural stress management for patients with non-insulin dependent diabetes mellitus. Psychology, Health & Medicine 2: 109–118.
Surwit RS, van Tilbur MA, Zucker N, et al, 2002 Stress management improves long-term glycemic control in type 2 diabetes. Diabetes Care 25: 30–34.
Rosenzweig S, Reibel DK, Greeson JM, et al, 2007 Mindfulness-based stress reduction is associated with improved glycemic control in type 2 diabetes mellitus: a pilot study. Altern Ther Health Med 13: 36–38.
McGinnis RA, McGrady A, Cox SA, Grower-Dowling KA, 2005 Biofeedback-assisted relaxation in type 2 diabetes. Diabetes Care 28: 2145–2149.
Aikens JE, Kiolbasa TA, Sobel R, 1997 Psychological predictors of glycemic change with relaxation training in non-insulin-dependent diabetes mellitus. Psychother Psychosom 66: 302–306.
Jacobson E, 1938 Progressive Relaxation. Chicago, University of Chicago Press.
Jablon SL, Naliboff BD, Gilmore SL, Rosenthal MJ, 1997 Effects of relaxation training on glucose tolerance and diabetic control in type II diabetes. Appl Psychophysiol Biofeedback 22: 155–169.
Panagiotakos DB, Pitsavos C, Stefanadis C, 2006 Dietary patterns: a Mediterranean diet score and its relation to clinical and biological markers of cardiovascular disease risk. Nutr Metab Cardiovasc Dis 16: 559–568.
Cohen S, Kamarck T, Mermelstein R, 1983 A global measure of perceived stress. J Health Soc Behav 24: 385–396.
Holmes TH, Rahe RH, 1967 The Social Readjustment Rating Scale. J Psychosom Res 11: 213–218.
Wallston KA, Wallston BS, DeVellis R, 1978 Development of the Multidimensional Health Locus of Control (MHLC) Scales. Health Educ Monogr 6: 160–170.
Karademas EC, 2009 Effects of exposure to the suffering of unknown persons on health-related cognitions, and the role of mood. Health (London) 13: 491–504.
Titlebaum HM, 1988 Relaxation. Holist Nurs Pract 2: 17–25.
Pawlow LA, Jones GE, 2005 The impact of abbreviated progressive muscle relaxation on salivary Cortisol and salivary immunoglobulin A (sIgA). Appl Psychophysiol Biofeedback 30: 375–387.
Sheu S, Irvin BL, Lin HS, Mar CL, 2003 Effects of progressive muscle relaxation on blood pressure and psychosocial status for clients with essential hypertension in Taiwan. Holist Nurs Pract 17: 41–47.
Anderson RE, Seniscal C, 2006 A comparison of selected osteopathic treatment and relaxation for tension-type headaches. Headache 46: 1273–1280.
van Rooijen AJ, Rheeder P, Eales CJ, Becker PJ, 2004 Effect of exercise versus relaxation on haemoglobin A1C in Black females with type 2 diabetes mellitus. QJM 97: 343–351.
Lane GD, McCaskill CC, Ross SL, Feinglos MN, Surwit RS, 1993 Relaxation training for NIDDM. Predicting who may benefit. Diabetes Care 16: 1087–1094.
Chrousos GP, 1998 Stressors, stress, and neuroendocrine integration of the adaptive response. The 1997 Hans Selye Memorial Lecture. Ann N Y Acad Sci 851: 311–335.
Morton NM, 2010 Obesity and corticosteroids: 11beta-hydroxysteroid type 1 as a cause and therapeutic target in metabolic disease. Mol Cell Endocrinol 316: 154–164.
Yang RB, Mark M, Gray A, et al, 1998 Toll-like receptor-2 mediates lipopolysaccharide-induced cellular signalling. Nature 395: 284–288.
Deitch EA, 1992 Multiple organ failure. Pathophysiology and potential future therapy. Ann Surg 216: 117–134.
Lehrer PM, Carr R, Sargunaraj D, Woolfolk RL, 1994 Stress management techniques: are they all equivalent, or do they have specific effects? Biofeedback Self Regul 19: 353–401.
Barbosa-Leiker C, Kostick M, Lei M, et al, 2012 Measurement Invariance of the Perceived Stress Scale and Latent Mean Differences across Gender and Time. Stress Health 29: 253–260.
Herrero SG, Saldana MA, Rodriguez JG, Ritzel DO, 2012 Influence of task demands on occupational stress: gender differences. J Safety Res 43: 365–374.
Rebbeck TR, Weber AL, Spangler E, Zeigler-Johnson CM, 2013 What stresses men? predictors of perceived stress in a population-based multi-ethnic cross sectional cohort. BMC Public Health 13: 113.
Bruehl H, Wolf OT, Convit A, 2009 A blunted Cortisol awakening response and hippocampal atrophy in type 2 diabetes mellitus. Psychoneuroendocrinology 34: 815–821.
Herbert TB, Cohen S, 1996 Measurement issues in research on psychosocial stress. In: HB Kaplan (ed) Psychosocial stress: Perspectives on structure, theory, life-course, and methods, Academic Press, London; pp, 295–332.
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Koloverou, E., Tentolouris, N., Bakoula, C. et al. Implementation of a stress management program in outpatients with type 2 diabetes mellitus: a randomized controlled trial. Hormones 13, 509–518 (2014). https://doi.org/10.14310/horm.2002.1492
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DOI: https://doi.org/10.14310/horm.2002.1492