Effects of relaxation training on glucose tolerance and diabetic control in type II diabetes

Mind- and Body-Based Interventions Improve Glycemic Control in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

Aims/Hypothesis: Only 51% of patients with type 2 diabetes achieve the hemoglobin A1c (HbA1c) <7% target. Mind and body practices have been increasingly used to improve glycemic control among patients with type 2 diabetes, but studies show inconsistent efficacy. The authors conducted a systematic review and meta-analysis to assess the association between mind and body practices, and mean change in HbA1c and fasting blood glucose (FBG) in patients with type 2 diabetes. Methods: The authors conducted a literature search of Ovid MEDLINE, Embase, and ClinicalTrials.gov seeking through June 10, 2022, published articles on mind and body practices and type 2 diabetes. Two reviewers independently appraised full text of articles. Only intervention studies were included. Reviewers extracted data for meta-analysis. Restricted maximum likelihood random-effects modeling was used to calculate the mean differences and summary effect sizes. The authors assessed heterogeneity using Cochran's Q and I² statistics. Funnel plots were generated for each outcome to gauge publication bias. Weighted linear models were used to conduct study-level meta-regression analyses of practice frequency. Results: The authors identified 587 articles with 28 meeting the inclusion criteria. A statistically significant and clinically relevant mean reduction in HbA1c of -0.84% (95% confidence interval [CI]: -1.10% to -0.58%; p < 0.0001) was estimated. Reduction was observed in all intervention subgroups: mindfulness-based stress reduction: -0.48% (95% CI: -0.72% to -0.23%; p = 0.03), qigong: -0.66% (95% CI: -1.18% to -0.14%; p = 0.01), and yoga: -1.00% (95% CI: -1.38% to -0.63%; p < 0.0001). Meta-regression revealed that for every additional day of yoga practice per week, the raw mean HbA1c differed by -0.22% (95% CI: -0.44% to -0.003%; p = 0.046) over the study period. FBG significantly improved following mind and body practices, with overall mean difference of -22.81 mg/dL (95% CI: -33.07 to -12.55 mg/dL; p < 0.0001). However, no significant association was found between the frequency of weekly yoga practice and change in FBG over the study period. Conclusions/Interpretation: Mind and body practices are strongly associated with improvement in glycemic control in patients with type 2 diabetes. The overall mean reduction in HbA1c and FBG was clinically significant, suggesting that mind and body practices may be an effective, complementary nonpharmacological intervention for type 2 diabetes. Additional analyses revealed that the mean decrease in HbA1c was greater in studies requiring larger number of yoga practice sessions each week.

Stress-Reducing Psychological Interventions as Adjuvant Therapies for Diabetic Chronic Wounds

BACKGROUND

Diabetic foot ulcers (DFUs) are a major complication of diabetes mellitus and a leading cause of lower limb amputation. Interventions to reduce psychological stress may have the potential to improve self-care and greatly reduce the morbidity and mortality associated with DFU. This review is focused on the consequences of psychological stress in wound healing and reflects on the effects of currently used psychological stress-reducing interventions in patients with DFU, proposing new applications for currently used stress-reduction interventions.

RESULTS

Stress is a natural and fundamental survival mechanism that becomes harmful when chronic. DFU is associated with high levels of anxiety and chronic psychological stress. Chronic stressinduced cortisol and adrenaline release impair wound healing, independently of the stressor. Psychological stress-reducing interventions, such as relaxation with guided imagery, biofeedback-assisted relaxation, mindfulness-based strategies, and hypnosis, can lead to a reduction in perceived stress and improve wound healing by reducing wound inflammation and pain while improving glycemic control. All stress reduction interventions also lead to pain relief and improved patient's quality of life.

CONCLUSION

Psychological stress-reducing interventions are promising adjuvant therapies for DFU. Their clinical application can improve self-care by tackling patient's expectations, anxieties, and fears. They can also help patients manage stress and pain while reducing wound inflammation and improving wound healing.

Experiences of Patients With a Diabetes Self-Care App Developed Based on the Information-Motivation-Behavioral Skills Model: Before-and-After Study

BACKGROUND

Mobile phones have been actively used in various ways for diabetes self-care. Mobile phone apps can manage lifestyle factors such as diet, exercise, and medication without time or place restrictions. A systematic review has found these apps to be effective in reducing blood glucose. However, the existing apps were developed and evaluated without a theoretical framework to explain the process of changes in diabetes self-care behaviors.

OBJECTIVE

This study aimed to evaluate the diabetes self-care app that we developed by measuring differences in diabetes self-care factors between before and after using the app with the Information-Motivation-Behavioral skills model of Diabetes Self-Care (IMB-DSC).

METHODS

We conducted a single-group pre- and postintervention study with a convenience sample of diabetes patients. A total of 38 adult patients with diabetes who had an Android smartphone were recruited. After conducting a preliminary survey of those who agreed to participate in the study, we provided them with a manual and a tutorial video about the diabetes self-care app. The app has functions for education, recommendations, writing a diary, recording, goal setting, sharing, communication, feedback, and interfacing with a glucometer, and it was applied for 4 weeks. We measured the general characteristics of participants, their history of diabetes self-care app usage, IMB-DSC factors, and blood glucose levels. The IMB-DSC factors of information, personal motivation, social motivation, behavioral skills, and behaviors were measured using an assessment tool consisting of 87 items extracted from the Diabetes Knowledge Test, third version of the Diabetes Attitude Scale, Diabetes Family Behavior Checklist, and Diabetes Self-Management Assessment Report Tool.

RESULTS

The mean age of the participants was 43.87 years. A total 30 participants out of 38 (79%) had type 2 diabetes and 8 participants (21%) had type 1 diabetes. The most frequently used app function was recording, which was used by 34 participants out of 38 (89%). Diabetes self-care behaviors (P=.02) and diabetes self-care social motivation (P=.05) differed significantly between pre- and postintervention, but there was no significant difference in diabetes self-care information (P=.85), diabetes self-care personal motivation (P=.57), or diabetes self-care behavioral skills (P=.89) between before and after using the diabetes self-care app.

CONCLUSIONS

Diabetes self-care social motivation was significantly improved with our diabetes self-care app by sharing experiences and sympathizing with other diabetes patients. Diabetes self-care behavior was also significantly improved with the diabetes self-care app by providing an interface with a glucometer that removes the effort of manual input. Diabetes self-care information, diabetes self-care personal motivation, and diabetes self-care behavioral skills were not significantly improved. However, they will be improved with additional offline interventions such as reflective listening and simulation.

Psychosocial aspects of diabetes management: dilemma of diabetes distress

Diabetes mellitus (DM) is a debilitating chronic illness with complex pathophysiological, psychological, and quality of life (QoL) implications creating a constant state of turbulence. Some of these interconnections are apparent to healthcare providers and are easily addressed in a routine diabetic clinical care. However, a large number of these hidden factors that interplay with each other and impact on the physical outcomes of DM goes unnoticed by health care providers. This is a frustrating and lonely predicament for DM patients making it very difficult for them to manage their illness well. At times these patients are mislabeled as "difficult patients". In other cases they are considered to have and unnecessarily treated for psychiatric illness like depression, other mood or anxiety spectrum disorders which they may not need. In recent years clinical researcher are making strides in understanding the emotional distress a DM patient may feel and the factors contributing or perpetuating diabetes distress. This article focuses on understanding the diabetes distress and how it impacts our patients, how to screen, assess, treat and eventually prevent it from happening. The paper also attempt to bring out the major differences between diabetes distress and common psychiatric comorbidities of DM including but not limiting to major depressive disorder and other depression spectrum disorders.

Evaluation of the UCL Diabetes Self-management Programme (UCL-DSMP): A Randomized Controlled Trial

Self-management has been described as the cornerstone of care for diabetes. Many self-management studies are limited by poor methodology and poor descriptions of the intervention. The current study developed a theoretically based self-management programme for patients with type 2 diabetes, which was evaluated via a randomized controlled trial. At immediate post-intervention and three-month follow-up the intervention group showed significant improvement relative to controls on self-management behaviours, quality of life and illness beliefs. A trend towards improved HbA1c was also observed. Documentation in a manual and development of a training programme for facilitators ensures the programme is replicable.

Effects of Music Therapy and Music-Assisted Relaxation and Imagery on Health-Related Outcomes in Diabetes Education

Purpose

The purpose of the feasibility study was to compare the effects of music-assisted relaxation and imagery, administered via compact disc recording (MARI CD) without therapeutic intervention, to the effects of music therapy (MT), facilitated by a board-certified music therapist, on selected health outcomes of patients enrolled in diabetes self-management education/training (DSME/T).

Methods

A 3-group, parallel, randomized controlled trial with 199 patients, aged 30 to 85 years with type 1, type 2, or prediabetes was employed. Patients were enrolled in a study from 2 hospital sites and randomly assigned to: DSME/T alone, DSME/T plus MARI CD, or DSME/T plus MT. The MARI CD included researcher-selected music and spoken suggestions, while MT included therapeutic experiences with personally preferred relaxing and energizing music. Outcome measures included blood pressure, glycosylated hemoglobin (A1C), body mass index (BMI), trait anxiety, state anxiety, and stress.

Results

There were no statistically significant differences among the 3 conditions in blood pressure, A1C, BMI, trait anxiety, or stress. Significant changes over time were evident in the MT condition from pre- to post-each session in systolic blood pressure, state anxiety, and stress. Blood pressure changes were compared pre- to postprogram for those patients with a comorbidity of hypertension between DSME/T alone and a combined music intervention group (MT and MARI CD). It was found that the music intervention group had a significantly larger decrease in systolic blood pressure. Themes derived from patient narratives further informed the data.

Conclusions

The study results support the relationship between DSME/T and improvement on all measured outcomes except blood pressure. Results suggest the feasibility of integrating MARI and MT with DSME/T to potentially lower systolic blood pressure of patients with diabetes and a comorbidity of hypertension. Collaboration between diabetes educators and board-certified music therapists is recommended.

Comparing Two Questionnaires for Eliciting CAM Use in a Multi-Ethnic US Population of Older Adults

INTRODUCTION: The NAFKAM International CAM Questionnaire (I-CAM-Q) was designed to facilitate cross-study comparisons of CAM usage. This research presents the first empirical study of the I-CAM-Q's performance. MATERIALS AND METHODS: Data were collected in two studies in a multi-ethnic (African American, American Indian, and white) population of older adults in the US. In 2010, 564 adults 60+ years were recruited. The I-CAM-Q was interviewer-administered. Data were compared to those collected in 2002 from a random sample of 701 Medicare recipients 65+ years. The 2002 survey included an extensive inventory of specific CAM therapies derived from local ethnographic research. Comparisons of the responses for 14 CAM modalities common to the two studies used logistic regression adjusted for demographics. RESULTS: There were no significant differences between the 2002 and 2010 surveys in the proportions reporting 10 modalities, including use of chiropractors, homeopaths, acupuncturists, herbalists, spiritual healers, vitamins, minerals, homeopathic remedies, Qigong, visualization, and prayer for health. Significantly less use of physicians and more use of relaxation techniques were reported in 2010. Herb use and garlic, as a specific herb, were reported significantly less in 2010. CONCLUSIONS: Overall, the I-CAM-Q obtained results similar to those produced by a population-specific questionnaire. Those differences observed appear to reflect differences in the studies' inclusion criteria or secular trends in CAM. This study supports the intention of the I-CAM-Q to substitute for local and regional surveys in order to allow cross-study comparisons of CAM use. Further tests, preferably through contemporaneous data collection are needed in other populations.

Alternative therapies useful in the management of diabetes: A systematic review

Diabetes mellitus is a metabolic disorder in the endocrine system. This dreadful disease is found in all parts of the world and becoming a serious threat of mankind health. There are lots of chemical agents available to control and to treat diabetic patients, but total recovery from diabetes has not been reported up to this date. In addition to adverse effects, drug treatments are not always satisfactory in maintaining euglycemia and avoiding late stage diabetic complications. Alternative to these synthetic agents, plants provided a potential source of hypoglycemic drugs and are widely used in several traditional systems of medicine to prevent diabetes. Several medicinal plants have been investigated for their beneficial effect in different type of diabetes. Other alternative therapies such as dietary supplements, acupuncture, hydrotherapy, and yoga therapies less likely to have the side effects of conventional approaches for diabetes.

Yoga Practice for the Management of Type II Diabetes Mellitus in Adults: A systematic review

The effect of practicing yoga for the management of type II Diabetes was assessed in this systematic review through searching related electronic databases and the grey literature to the end of May 2007 using Ovid. All randomized controlled clinical trials (RCTs) comparing yoga practice with other type of intervention or with regular practice or both, were included regardless of language or type of publication. Each study was assessed for quality by two independent reviewers. Mean difference was used for summarizing the effect of each study outcomes with 95% confidence intervals. Pooling of the studies did not take place due to the wide clinical variation between the studies. Publication bias was assessed by statistical methods. Five trials with 363 participants met the inclusion criteria with medium to high risk of bias and different intervention characteristics. The studies' results show improvement in outcomes among patients with diabetes type II. These improvements were mainly among short term or immediate diabetes outcomes and not all were statistically significant. The results were inconclusive and not significant for the long-term outcomes. No adverse effects were reported in any of the included studies. Short-term benefits for patients with diabetes may be achieved from practicing yoga. Further research is needed in this area. Factors like quality of the trials and other methodological issues should be improved by large randomized control trials with allocation concealment to assess the effectiveness of yoga on diabetes type II. A definitive recommendation for physicians to encourage their patients to practice yoga cannot be reached at present.

Stress management training in diabetes mellitus

Good diabetic control minimizes the risk of complications. Stress affects control directly through the release of hormones and indirectly by disrupting self-management activities. This review examines the impact of stress management interventions on glycaemic control. Qualifying studies since 1980 were identified using searches of Medline and PsycInfo databases. Ten were identified in adult populations, and four in adolescent populations. The general trend suggested that stress management interventions may be useful in management of diabetes. Further research will provide greater understanding of the particular benefits of various components of stress management training in relation to specific subgroups of the diabetic population.

An updated meta-analysis to assess the effectiveness of psychological interventions delivered by psychological specialists and generalist clinicians on glycaemic control and on psychological status

OBJECTIVE

To update a meta-analysis and determine the effectiveness of psychological interventions on glycaemic control measured by HbA(1c) and psychological status in type 2 diabetes and to compare effects when interventions are delivered by generalist clinicians compared to psychological specialists.

METHODS

We used the original review protocol and searched the Cochrane central register of controlled trials, Medline, Embase, PsychLIT, and Google Scholar from February 2003 (end of previous review) to March 2007. We extracted data on the participants, interventions, delivery methods, comparison groups and outcome measures.

RESULTS

35 trials were reviewed and meta-analysis of 19 trials (n=1431), reporting HbA(1c) found a reduction in HbA(1c) by 0.54% (-0.32; 95% CI: -0.47 to -0.16). In nine trials (n=832) interventions were delivered by diabetes or general clinicians reducing HbA(1c) by 0.51% (-0.27; 95% CI: -0.50 to 0.04). In nine trials, interventions (n=561) were delivered by psychological specialists reducing HbA(1c) by 0.57% (-0.36; 95% CI: -0.61 to 0.12). Meta-analysis of 13 trials reporting psychological status found psychological status to be lower in the intervention groups -0.56 (95% CI: 1.00 to -0.13). Trial quality for the majority of studies remained poor.

CONCLUSION

Our findings suggest that psychological and general clinicians are similarly effective in delivering psychological interventions, however, effect sizes for all clinicians have reduced since the earlier review.

PRACTICE IMPLICATIONS

Psychological training opportunities for generalist clinicians could lead to wider availability of effective psychological care.

Relaxation training for anxiety: a ten-years systematic review with meta-analysis

BACKGROUND

Relaxation training is a common treatment for anxiety problems. Lacking is a recent quantitative meta-analysis that enhances understanding of the variability and clinical significance of anxiety reduction outcomes after relaxation treatment.

METHODS

All studies (1997-2007), both RCT, observational and without control group, evaluating the efficacy of relaxation training (Jacobson's progressive relaxation, autogenic training, applied relaxation and meditation) for anxiety problems and disorders were identified by comprehensive electronic searches with Pubmed, Psychinfo and Cochrane Registers, by checking references of relevant studies and of other reviews. Our primary outcome was anxiety measured with psychometric questionnaires. Meta-analysis was undertaken synthesizing the data from all trials, distinguishing within and between effect sizes.

RESULTS

27 studies qualified for the inclusion in the meta-analysis. As hypothesized, relaxation training showed a medium-large effect size in the treatment of anxiety. Cohen's d was .57 (95% CI: .52 to .68) in the within analysis and .51 (95% CI: .46 to .634) in the between group analysis. Efficacy was higher for meditation, among volunteers and for longer treatments. Implications and limitations are discussed.

CONCLUSION

The results show consistent and significant efficacy of relaxation training in reducing anxiety. This meta-analysis extends the existing literature through facilitation of a better understanding of the variability and clinical significance of anxiety improvement subsequent to relaxation training.

Relaxation training for anxiety: a ten-years systematic review with meta-analysis

BACKGROUND

Relaxation training is a common treatment for anxiety problems. Lacking is a recent quantitative meta-analysis that enhances understanding of the variability and clinical significance of anxiety reduction outcomes after relaxation treatment.

METHODS

All studies (1997-2007), both RCT, observational and without control group, evaluating the efficacy of relaxation training (Jacobson's progressive relaxation, autogenic training, applied relaxation and meditation) for anxiety problems and disorders were identified by comprehensive electronic searches with Pubmed, Psychinfo and Cochrane Registers, by checking references of relevant studies and of other reviews. Our primary outcome was anxiety measured with psychometric questionnaires. Meta-analysis was undertaken synthesizing the data from all trials, distinguishing within and between effect sizes.

RESULTS

27 studies qualified for the inclusion in the meta-analysis. As hypothesized, relaxation training showed a medium-large effect size in the treatment of anxiety. Cohen's d was .57 (95% CI: .52 to .68) in the within analysis and .51 (95% CI: .46 to .634) in the between group analysis. Efficacy was higher for meditation, among volunteers and for longer treatments. Implications and limitations are discussed.

CONCLUSION

The results show consistent and significant efficacy of relaxation training in reducing anxiety. This meta-analysis extends the existing literature through facilitation of a better understanding of the variability and clinical significance of anxiety improvement subsequent to relaxation training.

The role of complementary and alternative medicine in diabetes

Complementary and alternative medicine (CAM) describes a diverse group of medical and health care systems, practices, and products not currently considered to be part of conventional medicine. Inadequacies in current treatments for diabetes have led 2 to 3.6 million Americans to use CAM for diabetes treatment, despite limited studies of safety and efficacy of CAM methods. CAM is used mostly by West Indians, Africans, Indians, Latin Americans, or Asians. Prayer, acupuncture, massage, hot tub therapy, biofeedback, and yoga have been used as well as various plant remedies for treating diabetes. Several CAM practices and herbal remedies are promising for diabetes treatment, but further rigorous study is needed in order to establish safety, efficacy, and mechanism of action. In the meantime, it is important to be aware that many patients with diabetes may be using CAM and to consider potential interactions with conventional medicines being used.

Biofeedback-assisted relaxation in type 2 diabetes

OBJECTIVE

The objective of this randomized controlled study was to determine the effects of biofeedback and relaxation on blood glucose and HbA1c (A1C) in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Patients with type 2 diabetes were randomized to either 10 sessions of biofeedback (electromyograph and thermal) and relaxation or 3 sessions of education. All sessions were individual. A total of 39 participants were entered, and 30 completed the 3-month protocol. Average blood glucose, A1C, forehead muscle tension, and peripheral skin temperature were assessed, and inventories measuring depression and anxiety were administered pre-randomization and after completion of treatment/control.

RESULTS

Biofeedback and relaxation were associated with significant decreases in average blood glucose, A1C, and muscle tension compared with the control group. At 3-month follow-up, the treatment group continued to demonstrate lower blood glucose and A1C. Both groups decreased scores on the depression and anxiety inventories. Patients with depression had higher blood glucose levels and tended to drop out of the study.

CONCLUSIONS

This study supports the use of biofeedback and relaxation in patients with type 2 diabetes for up to 3 months after treatment. Further research is necessary to determine the long-term effects of biofeedback and the effects of mood on patients' responses to treatment.

Self-management interventions for chronic illness

An increasing number of interventions have been developed for patients to better manage their chronic illnesses. They are characterised by substantial responsibility taken by patients, and are commonly referred to as self-management interventions. We examine the background, content, and efficacy of such interventions for type 2 diabetes, arthritis, and asthma. Although the content and intensity of the programmes were affected by the objectives of management of the illness, the interventions differed substantially even within the three illnesses. When comparing across conditions, it is important to recognise the different objectives of the interventions and the complexity of the issues that they are attempting to tackle. For both diabetes and asthma, the objectives are concerned with the underlying control of the condition with clear strategies to achieve the desired outcome. By contrast, strategies to deal with symptoms of pain and the consequences of disability in arthritis can be more complex. The interventions that were efficacious provide some guidance as to the components needed in future programmes to achieve the best results. But to ensure that these results endure over time remains an important issue for self-management interventions.

Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes

BACKGROUND

Adherence difficulties and psychological problems are associated with poor glycaemic control in diabetes. We undertook a systematic review and meta-analysis of psychological therapies to assess their effectiveness in improving glycaemic control in type 2 diabetes.

METHODS

We searched MEDLINE, PsychINFO, EMBASE, and the Cochrane Central Register of Controlled Trials up to January, 2003. Eligible studies were randomised controlled trials that involved people with type 2 diabetes and evaluated a psychological therapy (counselling, cognitive behaviour therapy, or psychodynamic therapy) to improve diabetes control. We extracted the number of participants, their age, duration of diabetes, glycaemic control, type of psychological therapy, its mode of delivery, and type of intervention in the control group. The main outcome was long-term glycaemic control measured by percentage of glycated haemoglobin. Blood glucose concentration, weight, and psychological distress were also measured. Pooled standardised effect sizes were calculated.

FINDINGS

25 trials were eligible for the review. In 12 trials, the mean percentage glycated haemoglobin was lower in people assigned a psychological intervention than in the control group (usual care, education, waiting list, or attention control); the pooled mean difference was -0.32 (95% CI -0.57 to -0.07) equivalent to an absolute difference of -0.76%. There were non-significant differences in blood glucose concentration (eight trials; -0.11 [-0.65 to 0.42]) and weight gain (nine trials; 0.37 [-0.18 to 0.93]). Psychological distress was significantly lower in the intervention groups (five trials; -0.58 [-0.95 to -0.20]).

INTERPRETATION

In type 2 diabetes, there are improvements in long-term glycaemic control and psychological distress but not in weight control or blood glucose concentration in people who receive psychological therapies.

Mind-Body Medicine in Ambulatory Care

Ambulatory medicine is a frequent clinical setting where practitioners can effectively apply Mind-body interventions ranging from basic stress management therapies to the sophisticated biomedical instrumentation of clinical biofeedback. Given the rather extensive and growing body of clinical research in this area, the intent of this article is to provide an evidence-based assessment of the evidence underlying the clinical efficiency of such interventions. Such an evidence-based approach can help ambulatory care providers to identify those Mind-body interventions with specific clinical indication so that they can be utilized both safely and effectively in ambulatory medicine.

A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus

Self-management and psychological interventions for diabetes have become increasingly common and have shown some positive impact on glycemic control. The association of such interventions with psychosocial outcomes is however, less clear. The current review examines the impact of these interventions on psychosocial outcomes including depression, anxiety, adjustment and quality of life. A systematic search of the literature was performed on Medline, Embase and Psychlit. Reference lists were screened for studies that met inclusion/exclusion criteria. Studies were coded on outcomes both over time and relative to control groups. In addition studies were classified as being principally educational, self-management or psychological in type, and the different components in the intervention were determined. Thirty-six studies were identified. Detrimental effects were not generally seen following any type of intervention. Depression seemed to be particularly improved following psychological interventions, whilst quality of life improved more following self-management interventions. A number of methodological issues, such as the specificity of measure used, characteristics of the population and type of intervention were however, influential in the impact of interventions on outcomes. It is recommended that future studies would benefit from being larger with controlled designs, using diabetes specific measures and providing clearer descriptions of intervention components. This will allow greater understanding of what contexts different interventions are most suited to, and which components are key to, improving psychological well-being and quality of life.

Stress management training as related to glycemic control and mood in adults with Type 1 diabetes mellitus

Relationships between attending a stress management and relaxation-training program, glycemic control (HbA(1c)) and mood were examined in two randomised groups of 31 persons with Type 1 diabetes. The program involved group-education 2 h a week for 14 weeks. Whereas one group received the program, the other acted as a control group and received the program later. HbA(1c) was measured and subjects filled out a mood adjective checklist before the start of intervention and both 1 month and 1 year after completing it. In both groups, significant positive mood changes were obtained, but no significant changes in HbA(1c) values occurred. No significant relationship was found between measures of change in HbA(1c) and of changes in mood. For those attending the group-sessions less frequently, the HbA(1c) values were significantly worse on each of the three measurement occasions than the values of those attending more frequently. The effectiveness of the program, with its failure to improve glycemic control but enhancing the mood of participants, is discussed in terms of characteristics of the sample and various methodological issues as well as in comparison with results of similar studies involving Type 1 and Type 2 diabetes.

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.

RESEARCH DESIGN AND 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.