Top 10 reads: Link between stress and Diabetes

A. STRESS AND DIABETES - AN OVERVIEW

Stress is a potential contributor to chronic hyperglycemia in diabetes. Although not a direct cause of diabetes, stress can cause a fluctuation in blood sugar in people with diabetes.

1. Stress Induced Diabetes 1

(Asian Journal of Research in Pharmaceutical Sciences. 2021 May 10)

Evidence suggest that stressful experience might affect diabetes. Many healthcare professionals believe that diabetes is case as a result of the changes or rise hormonal level as a result of stress. Long term stressors have a adverse effects on blood sugar level. The impact of stress on blood sugar varies from one patient to another. Medical studies have shown that physiological or mental stress can elevate blood glucose levels in individual with type 2 diabetes.  1

2. Work Environment-related Stress Factors are Correlated with Diabetes Development in Workers with Impaired Glucose Tolerance A 5-year Followup Study Using the Brief Job Stress Questionnaire 2

(Journal of UOEH. 2021 Jun 1)

Several previous studies have investigated the effects of occupational stress on the onset of diabetes mellitus. Low skill utilization might increase the risk of diabetes development in Japanese male workers. Longitudinal examination of the correlation between job stressors using the BJSQ and the development of DM in the employees of one company demonstrated that measures that promote mental health in the workplace are likely to generate a favorable cycle for DM control. It is essential to continue promoting comprehensive and advanced health management, not just to comply with the laws and regulations but also for fulfillment of the primary role of occupational health physicians.

3. Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic) 3

(BMJ Open Diab Res Care 2021)

An increase in perceived stress and anxiety, weight gain and less exercise but no deterioration of glycemic control occurs in both people with relatively well-controlled type 1 and type 2 diabetes during short-term lockdown measures. Additional risk factors for adverse outcomes of COVID-19, including poor glycemic control, do not appear to influence this effect. A third of the participants in the study reported elevated levels of stress, associated with difficulties in glycemic control, thus diabetes care professionals should take these aspects into account when discussing diabetes self-management and well-being during consultations.

B. STRESS MANAGEMENT APPROACHES IN DIABETICS

Patients with diabetes are more likely to experience negative emotions due to the level of stress caused by the disease. Technology can help support people with T2DM in the management of their psychological distress and stress.

4. Effect of Stress Management Coaching Intervention on Adult Learners with Type 2 Diabetes A Rational-Emotive Cognitive Behavioural Coaching Approach 4

(Journal of Rational-Emotive & Cognitive-Behavior Therapy. 2021 Nov 22)

 In developing regions, adult learners who are diabetic may not afford conventional diabetes care due to their income status and financial burdens. The effect of a rational-emotive cognitive behavioural coaching as a stress management program for assisting adult learners with type 2diabetes achieve reduced stress level was determined. Rational-emotive cognitive behavioral coaching as a stress management showed significant reduction in stress level which was maintained at follow-up compared to those in the waitlisted control group.

5. A feasibility study on low-dose mindfulness-based stress reduction intervention among prediabetes and diabetes patients 5

(Complementary Therapies in Medicine. 2022 Jan 29:102810)

Delivering a low-dose MBSR intervention to prediabetes/diabetes patients in a primary care setting is feasible. Participants indicated that they felt engaged in intervention sessions and reported positive overall experience with the intervention. The changes of psychological, behavioral and physical health outcomes observed in current study, although promising, should be interpreted with caution since the study sample size is small, and the comparisons were performed between pre- and post-intervention. Changes in the desired directions for depression, exercises, and glycemic control after the intervention was observed as compared with the pre-intervention.

6. Effectiveness of Mindfulness-Based Stress Reduction Training on Emotional Expressiveness and Fear of Hypoglycemia in Patients with Type 2 Diabetes 6

(Iranian journal of diabetes and obesity. 2021 Dec 12)

The effectiveness of mindfulness-based stress reduction training could improve emotional
expressiveness, prevent hypoglycemia and reduce the fear of it. Fear of hypoglycemia has a significant inverse correlation with the quality of life of diabetics. Therefore, special measures must be taken to prevent these complications. Mindfulness based stress reduction training provides the basis for improving emotional expressiveness by dentifying emotions and targeting diabetic patients' emotions and feelings. In addition, the use of ower-risk medications can reduce the fear of hypoglycemia in patients with type 2 diabetes and it can be considered as an essential need in them.

7. Emotional regulation and diabetes distress in adults with type 1 and type 2 diabetes. 7

(Diabetes Care. 2021 Jan 1)

Diabetes-related distress is meaningfully linked with negative emotionality, and skill at regulating such emotions, in adults with diabetes. This relationship appears to be stronger than that between diabetes-related distress and perceived psychological stress or diabetes self-care. Diabetes-related distress (and possibly A1C) may be improved in those with diabetes and difficulties with negative emotionality. Data of this kind could be used to develop a metric to identify those with diabetes who have difficulties with emotional regulation, who have elevated diabetes-related distress and have less than optimal glycemic regulation.

C. TECHNOLOGICAL ADVANCEMENTS IN MANAGING STRESS AND DIABETES

Technology availability in a near future already used by patients with diabetes. Technology is rapidly advancing to help people with diabetes mellitus manage stress. Digital products offering a flexible, person-centered approach including diabetes mellitus self-management tools and behavioral health skills and support may exhibit the most promise in improving disease-specific and psychosocial outcomes.

8. Physical Activity and Psychological Stress Detection and Assessment of Their Effects on Glucose Concentration Predictions in Diabetes Management 8

(IEEE Transactions on Biomedical Engineering. 2021 Jan 5)

Continuous glucose monitoring enables prediction of the future glucose concentration trajectory for making informed diabetes management decisions. The glucose concentration values are affected by various physiological and metabolic variations, such as physical activity and acute psychological stress, in addition to meals and insulin. The adaptive glucose modeling framework was extended to incorporate the effects of physical activity and acute psychological stress on the glucose concentration predictions making it the first ever glucose prediction model developed that incorporates measures of physical activity and acute psychological stress to improve glucose concentration prediction accuracy. Modeling the effects of physical activity and acute psychological stress on glucose concentration values will improve diabetes management and enable informed meal, activity and insulin dosing decisions.

9. Relationship Between Diabetes, Stress, and Self-Management to Inform Chronic Disease Product Development Retrospective Cross-Sectional Study 9

(JMIR diabetes. 2020 Dec 23)

Digital products that focus on the whole person by offering both diabetes mellitus self-management tools and behavioral health skills and support can help improve disease-specific and psychosocial outcomes. Rapid advancements in technology are advancing our ability to assess and treat a myriad of health concerns in real-time in the context of an individual’s life. This increased accuracy and timeliness represents an important step forward in the depth of understanding of this connection. Clinicians, researchers, product developers, software engineers, and other technology experts must come together to create clinically effective, cost effective, exciting, and engaging products to help people optimize all aspects of their health.

10. Assessment of Psychological Distress in Adults with Type 2 Diabetes Mellitus Through Technologies Literature Review 10

(Journal of medical Internet research. 2021 Jan 7)

The use of technological devices can support the self-management of individuals with type 2 diabetes mellitus (T2DM), particularly in addressing psychological distress. Effective programs for chronic disease management should combine relevant information systems, with constant follow-up and targeted self-management for patients. The deployment of appropriate psychological tools in digital interventions allows researchers and clinicians to make the screening of anxiety, stress, and depression symptoms Vfaster and easier in patients with T2DM

BJSQ: Brief Job Stress Questionnaire; DM: Diabetes mellitus; MBSR: Mindfulness-based stress reduction; T2DM: Type 2 diabetes mellitus;
COVID-19: Coronavirus 2019

    1. Baludas VP, Shivaji KK, Dadasaheb KA, Aappasaheb PS, Sitaram MD. Stress Induced Diabetes. Asian Journal of Research in Pharmaceutical Sciences. 2021 May 10;11(2):145-50.

    2. Sugito M, Okada Y, Torimoto K, Enta K, Tanaka Y. Work Environment-related Stress Factors are Correlated with Diabetes Development in Workers with Impaired Glucose Tolerance: A 5-year Follow-up Study Using the Brief Job Stress Questionnaire (BJSQ). Journal of UOEH. 2021 Jun 1;43(2):183-96.

    3. Ruissen MM, Regeer H, Landstra CP, Schroijen M, Jazet I, Nijhoff MF, Pijl H, Ballieux BE, Dekkers O, Huisman SD, de Koning EJ. Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic. BMJ Open Diabetes Research and Care. 2021 Jan 1;9(1):e002035.

    4. Koledoye UL, Ezenwaji CO, Aloh HE, Osilike CC, Ugwuoke NJ, Okeke P, Ekwealor NE, Ezenwaji IO. Effect of Stress Management Coaching Intervention on Adult Learners with Type 2 Diabetes: A Rational-Emotive Cognitive Behavioural Coaching Approach. Journal of Rational-Emotive & Cognitive-Behavior Therapy. 2021 Nov 22:1-6.

    5. Xia T, Lopes S, Chen L, Roth R, Zinzow H, Jones K, Zhang L, Shi L, Jindal M. A feasibility study on low-dose mindfulness-based stress reduction intervention among prediabetes and diabetes patients. Complementary Therapies in Medicine. 2022 May 1;65:102810.

    6. Abed MM, Azadi M, Dehghan M, Ardeshirpey J. Effectiveness of Mindfulness-Based Stress Reduction Training on Emotional Expressiveness and Fear of Hypoglycemia in Patients with Type 2 Diabetes. Iranian journal of diabetes and obesity. 2021 Dec 12.

    7. Coccaro EF, Lazarus S, Joseph J, Wyne K, Drossos T, Phillipson L, de Groot M. Emotional regulation and diabetes distress in adults with type 1 and type 2 diabetes. Diabetes Care. 2021 Jan 1;44(1):20-5.

    8. Sevil M, Rashid M, Hajizadeh I, Park M, Quinn L, Cinar A. Physical activity and psychological stress detection and assessment of their effects on glucose concentration predictions in diabetes management. IEEE Transactions on Biomedical Engineering. 2021 Jan 5;68(7):2251-60.

    9. Jessica SY, Xu T, James RA, Lu W, Hoffman JE. Relationship between diabetes, stress, and self-management to inform chronic disease product development: retrospective cross-sectional study. JMIR diabetes. 2020 Dec 23;5(4):e20888.

    10. Bassi G, Gabrielli S, Donisi V, Carbone S, Forti S, Salcuni S. Assessment of Psychological Distress in Adults With Type 2 Diabetes Mellitus Through Technologies: Literature Review. Journal of medical Internet research. 2021 Jan 7;23(1):e17740.

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