“The findings suggest a requirement to include a psychological consult in new patients with type 2 diabetes or patients with prediabetes,” Dr Shen told Endocrinology Advisor.

“For established patients with type 1 or type 2 diabetes, stress release may also help the management of hyperglycemia in addition to medical and lifestyle intervention. In some institutes, diabetes educators and physicians have incorporated this kind of education in their practice, but it has not been implied in the guidelines of the management of patients with type 2 diabetes,” Dr Shen added.


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Joseph Napora, PhD, author of Stress-Free Diabetes: Your Guide to Health and Happiness, noted that stress needs to be addressed in a more structured manner and placed at a higher rank as a risk factor for diabetes. 

“Stress is poison for someone with diabetes,” Dr Napora said in an interview. “Consider what many people do to soothe or moderate the discomfort of stress, which I define as a perceived uncontrollable threat. They eat excessively and eat rich foods because they are more comforting.”

Making the management of stress a higher priority in the mind of patients with diabetes is very important, he noted, but unfortunately, this requires significant time and a structured educational approach, which are not viewed as profitable in the short term.

Education is, however, profitable in the long term, according to Robert Ratner, MD, chief scientific and medical officer for the American Diabetes Association. He explained that providing patients with type 2 diabetes the information and tools they need to manage their disease is vital. Giving greater priority to the sources of stress is essential, he said, noting that the sources need to be clearly identified and then targeted for prevention.  

“There are a variety of determinants of health. The social environment plays a major role in the development of diabetes. It is why we have seen the incredible increase in prevalence. It relates to poverty and food insecurity and all of these lead to stress and we need to look at the sources of stress,” Dr Ratner said in an interview Endocrinology Advisor.

Additionally, patients with diabetes must manage their disease 24 hours a day, 7 days a week, and continually track their food intake, which creates significant stress in itself, he noted.

“The impact of that stress affects self-management,” said Dr Ratner.   “If an individual is stressed out about paying for their electricity or buying food for the family, then the care of their diabetes will be a secondary concern. From a physician’s standpoint, all we can do is recognize the stress and what effect it is having. If they can’t afford a brand-name drug, then there is no need to prescribe it.”

References

  1. Crump C, Sundquist J, Winkleby MA, Sundquist K. Stress resilience and subsequent risk of type 2 diabetes in 1.5 million young men. Diabetologia. 2016. doi:10.1007/s00125-015-3846-7.
  2. Novak M, Björck L, Giang KW, Heden-Ståhl C, Wilhelmsen L, Rosengren A. Perceived stress and incidence of Type 2 diabetes: a 35-year follow-up study of middle-aged Swedish men. Diabet Med. 2013;30(1):e8-e16. doi:10.1111/dme.12037.
  3. Winning A, Glymour MM, McCormick MC, Gilsanz P, Kubzansky LD. Psychological Distress Across the Life Course and Cardiometabolic Risk: Findings From the 1958 British Birth Cohort Study. J Am Coll Cardiol. 2015;66(14):1577-1586. doi:10.1016/j.jacc.2015.08.021.