Effects of EMG biofeedback on diabetes

Relaxation training significantly reduced blood glucose levels in patients with type 1 diabetes mellitus

PURPOSE/OBJECTIVE

The present study was designed to test whether adding a relaxation training technique to the medical treatment of patients with type 1 diabetes mellitus could, adjusting for the non-specific factors of therapy, lead to an improvement in the patients' condition.

METHOD

Forty-six participants were randomly allocated either to an experimental (intervention) group, receiving weekly sessions of relaxation training, or to a control group (placebo) receiving weekly blood circulation training exercises. Measures included the State and Trait Anxiety Inventory, blood glucose levels, high-density lipoprotein levels, cholesterol levels, body weight, HbA1c levels, the Mood Adjective Checklist (MACL), a diary checklist, and urine glucose levels. Assessment of psychological and physiological parameters was conducted before and upon completion of the intervention (8 weeks).

RESULTS

Trait anxiety and the main metabolic measurement of blood glucose levels and HbA1C revealed significant differences over time, predominantly among patients in the intervention group.

CONCLUSIONS

Relaxation techniques as an adjunct to medical treatment are a useful tool for patients with type 1 diabetes mellitus.

SIGNIFICANCE OF ELECTROMYOGRAPHY IN THE ASSESSMENT OF DIABETIC NEUROPATHY

Diabetic neuropathy is one of the physical complications of diabetes mellitus (DM) patients with a long history of diabetes. An electromyography (EMG)-based assessment may be very useful for the management of diabetic neuropathy. In the present study, we aimed to summarize all of the findings and recommendations obtained from previous studies that investigated the application of EMG to the assessment of diabetic neuropathy. An extensive search of the prominent electronic databases PubMed, Google Scholar and Scopus was performed to evaluate the following areas: (i) what are the muscles to be evaluated by EMG for neuropathy assessment, (ii) what type of EMG methodologies have been used and (iii) what recommendation can be made for neuropathy detection. The major findings are summarized as follows: (i) very few studies have analyzed the correlation of the EMG signals acquired from peripheral muscles affected in neuropathy with those obtained with non-neuropathic complications, such as ankle sprain; (ii) EMG has been applied for the detection of diabetic neuropathy more than diabetes treatment; and (iii) neuropathy detection using an EMG-based assessment were mainly performed for type 2 DM patients aged at least 50 years.

Stress and metabolic control in diabetes mellitus: methodological issues and an illustrative analysis

RATIONALE

The purpose of this article was twofold: a) to review studies of stress and glycemic control in diabetes, and b) to present a data analysis that illustrates the complexities of investigating stress in relation to blood glucose. The literature review emphasized human studies and the strengths and weaknesses of alternative designs. Special consideration was given to longitudinal investigations, and an analysis of data from the Diabetes Control and Complications Trial (DCCT) was presented to exemplify this approach. Nine individuals with Type 1 diabetes who participated in this project at the University of Iowa were studied over a period of 2 years. Stress was multiply measured (Life Experiences Survey, Hassles Scale, Perceived Stress Scale) as was blood glucose control (daily reflectance meter readings; monthly HbA1c). Within-subject time-series analyses and a combined longitudinal/cross-sectional model were used to analyze data. Two of the nine subjects manifested significant correlations between stress and HbA1c, and six subjects exhibited significant associations between stress and daily level or variability of glucose readings. The latter correlations varied in sign and appeared to cluster around specific individuals rather than a particular measure of stress or blood glucose.

CONCLUSION

While the subjects may not represent the full spectrum of individuals with Type 1 diabetes, results were consistent with earlier longitudinal research in suggesting that the strength and direction of the relationship between stress and blood glucose control varies considerably between individuals.

A nomothetic-idiographic study of daily psychological stress and blood glucose in women with type I diabetes mellitus

Although there has been some study of the extralaboratory generality of stress effects on diabetic metabolism, analysis of the diabetic response to everyday life stress is needed. The secondary objective of this study was to investigate whether personal characteristics moderate the daily stress-glucose relationship. Twenty-five women with Type I diabetes completed measures of internality and self-esteem and subsequently monitored daily stress and blood glucose for 30 consecutive days. Data were analyzed by both time-series and conventional correlational analyses. Glucose was higher on high-stress days than on low-stress days, with one-third of the sample showing significant positive associations between stress and same-day glucose. However, stress showed little relation to next-day glucose. Personal characteristics failed to explain differences in stress-glucose associations. Implications for practice and future research are presented.

Management of a patient with insulin-dependent diabetes mellitus learning biofeedback-assisted relaxation

Psychological stress can have profound disruptive effects upon glycemic control in individuals with diabetes. Presented here is a case study in which biofeedback-assisted relaxation techniques were used to help a young woman with a 10-year history of insulin-dependent diabetes mellitus to more effectively manage stress, thereby improving glycemic control. Hypoglycemia is a frequently encountered problem with this technique, so the patient was taught to identify causes of hypoglycemic episodes and to take action to prevent their occurrence. The team approach of a diabetes nurse educator working in conjunction with a biofeedback therapist was vital to the success of this program.

Clinical observations on behavioral treatment of a patient with insulin-dependent diabetes mellitus

This report uses a single case format to describe clinical observations on the use of biofeedback-assisted relaxation in Type I insulin-dependent diabetes mellitus. It is suggested that treatment based on relaxation training may be utilized in diabetics provided that certain conditions are met and that the relaxation procedure is modified to conform to the special requirements of persons taking insulin. Since both client characteristics and type of training protocol can markedly affect outcome, it may be especially important to tailor the training protocol for each insulin-dependent diabetic patient, based on careful and continuous monitoring of treatment effects.

Psychosocial correlates of hemoglobin Alc in young adults with type I diabetes

To determine whether psychosocial variables are related to long-term glycemic control; trait anxiety, depression, loneliness and life stress were assessed in 48 Type I diabetic patients. Hemoglobin A1c (HbA1c), an indicator of long-term glycemic utilization, was assayed from blood samples drawn shortly before the self-report instruments were administered. Of the psychosocial variables, anxiety was significantly related to current values of HbA1c. The association between anxiety and current HbA1c remained after statistically controlling for potentially confounding variables, including the previous value of HbA1c. Despite the stability of HbA1c values over time, anxiety scores were not significantly correlated with follow-up HbA1c. The implications of the significant relationships between psychological constructs and glycemic control are discussed.

Innovations in behavioral medicine

The chapter begins with a brief history of the behavioral medicine movement along with an overview of contemporary activities in the field. Three subsequent sections review technical innovations in major areas of clinical behavioral medicine: treatment, health care delivery, and preventive health care. The final section describes the methodological characteristics of research in behavioral medicine, discusses the field in light of the psychosomatic medicine and behavior modification movements, and calls for a conceptual integration that is authentically behavioristic. Already the quality of research in behavioral medicine appears comparable to that of research in behavior therapy. Even so, when viewed in terms of contemporary methodological desiderata, most of the work is fairly unimpressive. Possibly needed are "hybrid" experimental approaches in which the inferential power of intrasubject phase manipulations and between-subject outcome comparisons are combined. There is good reason to believe that behavioral medicine will follow the historical course of behavior therapy/modification, not the course of psychosomatic medicine. Behaviorally knowledgeable psychologists can become major service providers in liaison with well-informed medical practitioners. Some potentially deleterious influences on the behavioral medicine movement are (inevitable) mentalistic and dualistic thinking and a retreat toward psychosomatic medicine. Field behaviorism as an organizing schema can, in principle, serve as a safeguard against such untoward influences.

Emotional stress and diabetic control: a postulated model for the effect of emotional distress upon intermediary metabolism in the diabetic

The findings of a number of clinical investigators across a wide variety of situations and using a wide variety of observational procedures agree on the disruptive effects of emotional distress upon diabetic control. An integrative model of coordinated neural and hormonal reactions to emotional stress and their additive and potentiating effects on intermediary metabolism is proposed. The end result of these effects, as part of a general fight/flight or defense-alarm reaction, is a strong energy mobilization response (namely, a sharp rise in blood glucose and free fatty acid levels resulting in increased levels of serum cholesterol, triglycerides, and ketone bodies), which the diabetic cannot readily counterregulate. It is further proposed that increased diabetic control, together with lower insulin requirements, may result from the inclusion of stress management procedures as an adjunct to traditional medical treatment. The findings of a large number of investigators supporting these propositions are presented and discussed.

The effects of cognitive task demand on subjective stress and blood glucose levels in diabetics and non-diabetics

Blood glucose levels (BGLs) and subjective estimate of stress levels (SESLs) were measured repeatedly in 45 min baseline sessions on three successive days in insulin-dependent diabetic and non-diabetic groups. In the diabetic groups the initial level of BG was twice that of the non-diabetic group and BGLs declined steadily within each session but not across sessions whereas BGLs in the non-diabetic group remained steady both within and across sessions. On two subsequent days half of each group performed a high demand and half a low demand task, BGLs and SESLs being assessed before, during and after the stress period. Stress did not appear to induce significant changes in BGL in any of the groups even though SESL measures indicated that the task appeared stressful to the groups. The implications of these findings for the relationship between stress and increases or decreases in BGL are discussed.

Physiological and metabolic responses to brief stress in non-insulin dependent diabetic and control subjects

Eight non-insulin dependent diabetic subjects and eight controls were studied during physical and psychological stress. Physiological measures of heart rate, finger pulse amplitude and blood pressure, as well as metabolic measures of blood glucose, insulin, catecholamines and glucagon were sampled during the experiment. Results indicate substantial physiological arousal during the tasks for both groups, but no changes in blood glucose. Despite signs of mild autonomic neuropathy, the diabetic subjects showed responses similar to the controls on the stress tasks. Overall, this study suggests that diabetic instability does not necessarily follow from physiological activity and stress hormone elevations.

Implications of psychological and family factors in the treatment of diabetes

The authors delineate and discuss in detail those psychological and familial factors that have implications in treatment and in fostering the optimal emotional and physical health of children and adolescents with diabetes mellitus.

Biofeedback-assisted stress management for insulin-treated diabetes mellitus

Six insulin-treated diabetic patients (four with type I and two with type II) who completed a biofeedback-assisted stress management program based on family systems theory improved their response to life stressors, and none had negative side effects. Four decreased their insulin requirement, including one who remained stable even during two pregnancies; the sixth became stable and discontinued drug abuse. All started biofeedback for reasons other than diabetes. Follow-ups of some individuals extend over 4 years.

The use of EMG biofeedback with insulin-dependent diabetic patients

A recent report on the use of EMG biofeedback with an insulin-dependent diabetic is discussed. An examination of the role of EMG biofeedback in the management of carbohydrate metabolism is presented. While still an empirical question, it is concluded that EMG biofeedback will prove most useful in cases where a demonstrable relationship between stress and carbohydrate metabolism is evidenced.