Skip to main content

Advertisement

Log in

Stress and Chronic Illness: the Case of Diabetes

  • Published:
Journal of Adult Development Aims and scope Submit manuscript

Abstract

Globally, Type 2 Diabetes Mellitus (T2DM) is one of the most prevalent chronic illnesses. Managing T2DM is a major challenge now affecting the lives of around 200 million people. Even when medication, diet, and physical activity regimens are maintained, blood sugar levels might not be effectively controlled because stress triggers the release of sugar into the blood. This makes the management of stress an important adjunct to the treatment of T2DM. Stress includes both life stress, the major issues that people face in their lives, such as job loss, divorce, or death of a loved one, and daily hassles, smaller everyday problems, such as deadlines for work, traffic hold-ups, or family disagreements. The stress levels created by these events are exacerbated by the stress created by the demands of managing diabetes. In this paper, we first examine the evidence for the relationship between stress and poor blood sugar control in people with T2DM. Then, we consider research that has examined the impact of various stress management strategies on blood sugar level. Finally, we discuss some promising psychological techniques for managing stress that could be helpful for people with diabetes or pre-diabetes. We note the double benefit of physical activity, which directly assists in the metabolism of sugar from the blood and indirectly reduces acute stress and chronic stress reactivity, thus providing a buffer against the effects of stress for people with T2DM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Aikens, J., Wallander, J., Bell, D., & Cole, J. (1992). Daily stress variability, learned resourcefulness, regimen adherence, and metabolic control in type 1 diabetes mellitus: Evaluation of a path model. Journal of Consulting and Clinical Psychology, 60, 113–118.

    Article  PubMed  Google Scholar 

  • Aitkens, J. E., Kiolbasa, T. A., & Sobel, R. (1997). Psychological predictors of glycemic change with relaxation training in non-insulin-dependent diabetes mellitus. Psychotherapy and Psychosomatics, 66, 302–306.

    Article  Google Scholar 

  • American Diabetes Association. (2007a). Standards of medical care in diabetes-2007. Diabetes Care, 30(S1), S4–S41.

    Article  Google Scholar 

  • American Diabetes Association. (2007b). Diagnosis and classification of diabetes mellitus. Diabetes Care, 30(S1), S42–S47.

    Article  Google Scholar 

  • Antoni, M. (1987). Neuroendocrine influences in psychoimmunology and neoplasia: A review. Psychology and Health, 1, 3–24.

    Article  Google Scholar 

  • Attari, A., Sartippour, M., Amini, M., & Haghighi, S. (2006). Effect of stress management training on glycemic control in patients with type 1 diabetes. Diabetes Research and Clinical Practice, 73, 23–28.

    Article  PubMed  Google Scholar 

  • Barr, E., Magliano, D., Zimmet, P., Polkinghorne, K., Atkins, R., Dunstan, D., et al. (2006). AusDiab 2005: The Australian diabetes, obesity and lifestyle study. Australia: International Diabetes Institute Melbourne.

    Google Scholar 

  • Batch, B., & Surwit, R. (2008). Diabetes mellitus type 2 and stress: Pathophysiology and treatment. In M. Feinglos & M. Bethel (Eds.), Type 2 diabetes mellitus: An evidence-based approach to practical management (pp. 433–438). Totowa, USA: Human Press.

    Google Scholar 

  • Berger, B. G., Pargman, D., & Weinberg, R. S. (2006). Foundations of exercise psychology (2nd ed.). Morgantown, WV: Fitness Information Technology Inc.

    Google Scholar 

  • Bradshaw, B. G., Richardson, G. E., Kumpfer, K., Carlson, J., Stanchfield, J., Overall, J., et al. (2007). Determining the efficacy of a resiliency training approach in adults with type 2 diabetes. Diabetes Educator, 33, 650–659.

    Article  PubMed  Google Scholar 

  • Bruce, D., Chisholm, D., Storlien, L., Kraegen, E., & Smythe, G. (1992). The effects of sympathetic nervous system activation and psychological stress on glucose metabolism and blood pressure in subjects with type 2 (non-insulin dependent) diabetes mellitus. Diabetologia, 35, 835–843.

    Article  PubMed  Google Scholar 

  • Cohen, M., & Kanter, Y. (2004). Relation between sense of coherence and glycemic control in type 1 and type 2 diabetes. Behavioural Medicine, 29, 175–183.

    Article  Google Scholar 

  • Cooper, C., & Palmer, S. (2000). Conquer your stress (Management Shapers) (pp. 9–10). London, UK: Chartered Institute of Personnel & Development.

    Google Scholar 

  • Cox, D., & Gonder-Frederick, L. (1992). Major developments in behavioral diabetes research. Journal of Consulting and Clinical Psychology, 60, 628–638.

    Article  PubMed  Google Scholar 

  • De Rivera, J. L. G., de las Cuevas, C., Monterrey, A. L., Rodriguez, F., & Gracia, P. R. (1993). Stress reactivity in the general population. European Journal of Psychiatry, 7(1), 5–11.

    Google Scholar 

  • Esposito-Del, P., Lillioja, S., Bogardus, C., McCubbin, J., Feinglos, M., Kuhn, C. M., et al. (1994). Glycemic response to stress is altered in euglycemic Pima Indians. International Journal of Obesity Related Metabolic Disorders, 18, 766–770.

    Google Scholar 

  • Feinglos, M. N., Hastedt, P., & Surwit, R. S. (1987). The effects of relaxation therapy on patients with type 1 diabetes mellitus. Diabetes Care, 10, 72–75.

    Article  PubMed  Google Scholar 

  • Goetsch, V., Wiebe, D., Veltum, L., & Van Dorsten, B. (1990). Stress and blood glucose in type II diabetes mellitus. Behaviour Research and Therapy, 28, 531–537.

    Article  PubMed  Google Scholar 

  • Gonder-Frederick, L., Carter, W., Cox, D., & Clarke, W. (1990). Environmental stress and blood glucose change in insulin dependent diabetes mellitus. Health Psychology, 9, 503–515.

    Article  PubMed  Google Scholar 

  • Gottlieb, B. H. (1997). Coping with chronic stress. New York: Plenum Press.

    Google Scholar 

  • Gregg, J. A., Callaghan, G. M., & Hayes, S. C. (2007a). The diabetes lifestyle book. Oakland, CA: New Harbinger.

    Google Scholar 

  • Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Glenn-Lawson, J. L. (2007b). Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 75, 336–343.

    Article  PubMed  Google Scholar 

  • Gupta, R., & Kumar, P. (2008). Global diabetes landscape- type 2 diabetes mellitus in South Asia: Epidemiology, risk factors, and control. Insulin, 3, 78–94.

    Article  Google Scholar 

  • Hackshaw, A. (2008). Small studies: Strengths and limitations. European Respiratory Journal, 32, 1141–1143.

    Article  PubMed  Google Scholar 

  • Halford, W., Cuddihy, S., & Mortimer, R. (1990). Psychological stress and blood glucose regulation in type 1 diabetic patients. Health Psychology, 9, 516–528.

    Article  PubMed  Google Scholar 

  • Hanson, S., & Pichert, J. (1986). Perceived stress and diabetes control in adolescents. Health Psychology, 5, 439–452.

    Article  PubMed  Google Scholar 

  • Harris, R. (2006). Embracing your demons: An overview of acceptance and commitment therapy. Psychotherapy in Australia, 12, 1–8.

    Google Scholar 

  • Hislop, A., Fegan, P., Schlaeppi, M., Duck, M., & Yeap, B. (2008). Prevalence and associations of psychological distress in young adults with type 1 diabetes. Diabetic Medicine, 25, 91–96.

    Article  PubMed  Google Scholar 

  • Inui, A., et al. (1998). Effect of the Kobe earthquake on stress and glycemic control in patients with diabetes mellitus. Archives of Internal Medicine, 158, 274–278.

    Article  PubMed  Google Scholar 

  • Jablon, S. L., Nabiloff, B. D., Gilmore, S. L., & Rosenthal, M. J. (1997). Effects of relaxation training on glucose tolerance and diabetic control in type II diabetes. Applied Psychophysiology and Biofeedback, 22, 155–169.

    Article  PubMed  Google Scholar 

  • Jain, S. C., Uppal, A., Bhatnagar, S. O., & Talukdar, B. (1993). A study of response pattern of non-insulin dependent diabetics to yoga therapy. Diabetes Research and Clinical Practice, 19, 69–74.

    Article  PubMed  Google Scholar 

  • Karlsen, B., Idsoe, T., Dirdal, I., Hanestad, B. R., & Bru, E. (2004). Effects of a group-based counselling programme on diabetes-related stress, coping, psychological well-being and metabolic control in adults with type 1 or type 2 diabetes. Patient Education and Counseling, 53, 299–308.

    Article  PubMed  Google Scholar 

  • Kaufman, F. (2002). Type 2 diabetes in children and young adults: A “new epidemic”. Clinical Diabetes, 20, 217–218.

    Article  Google Scholar 

  • Kemmer, F., Bisping, R., Steinbruber, H., Baar, H., Hardtmann, F., Schlaghecke, R., et al. (1986). Psychological stress and metabolic control in patients with type 1 diabetes mellitus. New England Journal of Medicine, 314, 1078–1084.

    Article  PubMed  Google Scholar 

  • Kirk, A., Barnett, J., & Mutrie, N. (2007). Physical activity consultation for people with type 2 diabetes. Evidence and guidelines. Diabetes Medicine, 24, 809–816.

    Article  Google Scholar 

  • Kirk, A., & De Feo, P. (2007). Strategies to enhance compliance to physical activity for patients with insulin resistance. Applied Physiology Nutrition and Metabolism, 32(3), 549–556.

    Article  Google Scholar 

  • Kramer, J., Ledolter, J., Manos, G., & Bayless, M. (2000). Stress and metabolic control in diabetes mellitus: Methodological issues and an illustrative analysis. Annals of Behavioral Medicine, 22, 17–28.

    Article  PubMed  Google Scholar 

  • Landel-Graham, J., Yount, S., & Rudnicki, S. (2003). Diabetes mellitus. In A. Nezu, C. Nezu, & P. Geller (Eds.), Handbook of psychology, Vol 9, health psychology. New York: Wiley.

    Google Scholar 

  • Landers, D. M., & Alderman, B. (2007). Exercise relative to other treatments for reduction of anxiety/depression: Overcoming the principle of least effort. In T. Morris, P. Terry, & S. Gordon (Eds.), Sport and exercise psychology: International perspectives (pp. 83–94). Morgantown, WV: Fitness Information Technology.

    Google Scholar 

  • Lloyd, C., Dyer, P., Lancashire, R., Harris, T., Daniels, J., & Barnett, A. (1999). Association between stress and glycemic control in adults with type 1 (insulin-dependent) diabetes. Diabetes Care, 22, 1278–1283.

    Article  PubMed  Google Scholar 

  • Loughlan, C., & Mutrie, N. (1995). Conducting an exercise consultation: Guidelines for health professionals. Journal of the Institute of Health Education, 33, 78–82.

    Google Scholar 

  • McCraty, R., Atkinson, M., & Lipsenthal, L. (1999). Emotional self-regulation program enhances psychological health and quality of life in patients with diabetes. In Proceedings of the society of behavioral medicine 20th annual scientific sessions (pp. 1–11). San Diego, CA: Society of Behavioral Medicine.

  • McGinnis, R. A., Cox, S. A., McGrady, A., & Growler-Dowling, K. A. (2005). Biofeedback-assisted relaxation in type 2 diabetes. Diabetes Care, 28, 2145–2149.

    Article  PubMed  Google Scholar 

  • McGrady, A., Bailey, B. K., & Good, M. P. (1991). Controlled study of biofeedback-assisted relaxation in type 1 diabetes. Diabetes Care, 5, 360–365.

    Article  Google Scholar 

  • McGrady, A., & Gerstenmeier, L. (1990). Effect of biofeedback-assisted relaxation training on blood glucose levels in type 1 insulin-dependent diabetics: A case report. Journal of Behavioral Therapy and Experiential Psychiatry, 21, 69–75.

    Article  Google Scholar 

  • McQuaid, J. R., Monroe, S. M., Roberts, J. R., Johnos, S. L., Garamoni, G. L., Kupfer, D. L., & Frank, E. (1992). Toward a standardization of life stress assessment: Definitional discrepancies and inconsistencies in methods. Stress Medicine, 8, 47–56.

    Article  Google Scholar 

  • Miller, C., Lawrence, P., Ziemer, D., Galliner, D., Cook, C., & El-Kebbi, I. (2001). Clinical inertia. Archives of Internal Medicine, 161, 1653–1659.

  • Morris, T. (2002). Diabetes in sport and exercise. In D. I. Mostofsky & L. Zaichkowsky (Eds.), Handbook on the medical aspects of sport and exercise. Morgantown, WV: Fitness Information Technology.

    Google Scholar 

  • Naliboff, B., Cohen, M., & Sowers, J. (1985). Physiological and metabolic responses to brief stress in non-insulin dependent diabetic and control subjects. Journal of Psychosomatic Research, 4, 367–374.

    Article  Google Scholar 

  • Nomura, M., et al. (2000). Stress and coping behaviour in patients with diabetes mellitus. Acta Diabetologica, 37, 61–64.

    Article  PubMed  Google Scholar 

  • Nozaki, T., Morita, C., Matsubayashi, S., Ishido, K., Yokoyama, H., Kawai, K., et al. (2009). Relation between psychosocial variables and the glycemic control of patients with type 2 diabetes: A cross-sectional and prospective study. BioPsychoSocial Medicine, 3, 1–8.

    Article  Google Scholar 

  • Pate, R., Pratt, M., Blair, S., Haskell, W., Macera, C., Bouchard, C., et al. (1995). Physical activity and public health—A recommendation from the centers for disease control and prevention and the American college of sports medicine. Journal of the American Medical Association, 273, 402–407.

    Article  PubMed  Google Scholar 

  • Pearlin, L., Menaghan, E., Lieberman, M., & Mullan, J. (1981). The stress process. Journal of Health and Social Behavior, 22, 337–356.

    Article  PubMed  Google Scholar 

  • Peyrot, M., McMurray, J., & Kruger, D. (1999). A biopsychosocial model of glycemic control in diabetes: Stress, coping, and regimen adherence. Journal of Health and Social Behavior, 40, 141–158.

    Article  PubMed  Google Scholar 

  • Riazi, A., Pickup, J., & Bradley, C. (2004). Daily stress and glycaemic control in type 1 diabetes: Individual differences in magnitude, direction, and timing of stress-reactivity. Diabetes Research and Clinical Practice, 66, 237–244.

    Article  PubMed  Google Scholar 

  • Rosenbaum, L. (1990). Biofeedback-assisted stress management for insulin-treated diabetes mellitus. Biofeedback Self-regulation, 8, 519–532.

    Article  Google Scholar 

  • Ryden, L., et al. (2007). Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: Full text. European Heart Journal Supplements, 9, C3–C74.

    Article  Google Scholar 

  • Semmer, N., McGrath, J., & Beehr, T. (2004). Conceptual issues in research on stress and health chapter 1. In C. Cooper (Ed.), Handbook of stress, medicine and health (2nd ed., pp. 1–45). USA: CRC Press.

    Chapter  Google Scholar 

  • Sigal, R., Kenny, G., Wasserman, D., Castaneda-Sceppa, C., & White, R. (2006). Physical activity/exercise and type 2 diabetes: A consensus statement from the American Diabetes Association. Diabetes Care, 29, 1433–1438.

    Article  PubMed  Google Scholar 

  • Steinhardt, M. A., Mamerow, M. M., Brown, S. A., & Jolly, C. A. (2009). A resilience intervention in African American Adults with type 2 diabetes. The Diabetes Educator, 35, 274–284.

    Article  PubMed  Google Scholar 

  • Stowel, J., McGuire, L., Robles, T., Glaser, R., & Kiecolt-Glaser, J. (2003). Psychoneuroimmunology. In A. Nezu, C. Nezu, P. Geller, & I. Weiner (Eds.), Handbook of psychology: Health psychology (Vol. 9, pp. 75–99). USA: Wiley.

    Google Scholar 

  • Sultan, S., & Heurtier-Haremann, A. (2001). Coping and distress as predictors of glycemic control in diabetes. Journal of Health Psychology, 6, 731–739.

    Article  Google Scholar 

  • Surwit, R. S., & Feinglos, M. N. (1983). The effects of relaxation on glucose tolerance in non-insulin dependent diabetes. Diabetes Care, 6, 176–179.

    Article  PubMed  Google Scholar 

  • Surwit, R. S., Feinglos, M. N., van Tilburg, M. A. L., Edwards, C., Zucker, N., Williams, P., et al. (2002). Stress management improves long-term glycemic control in type 2 diabetes. Diabetes Care, 25, 30–34.

    Article  PubMed  Google Scholar 

  • Tsujiuchi, T., Kumano, H., Yoshuchi, K., He, D., Tsujiuchi, Y., Kuboki, T., et al. (2002). The effect of Qi-Gong relaxation exercise on the control of type 2 diabetes mellitus. Diabetes Care, 25, 241–242.

    Article  PubMed  Google Scholar 

  • Weiten, W. (2008). Psychology: Themes and variations (8th ed.). Canada: Wadsworth.

    Google Scholar 

  • Wheeler, H. (1998). Nurse occupational stress research 6: Methodological approaches. British Journal of Nursing, 7, 226–229.

    PubMed  Google Scholar 

  • Wieslie, P., Krayenbuhl, P., Kerwer, O., Seifert, B., & Schmid, C. (2007). Maintenance of glucose control in patient with type 1 diabetes during acute mental stress by riding high-speed rollercoasters. Diabetes Care, 30, 1599–1601.

    Article  Google Scholar 

  • Wild, S., Roglic, G., Green, A., Sicree, R., & King, H. (2004). Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care, 27, 1047–1053.

    Article  PubMed  Google Scholar 

  • Zimmet, P., Alberti, K. G. M. M., & Shaw, J. (2001). Global and societal implications of the diabetes epidemic. Nature, 414, 782–787.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tony Morris.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Morris, T., Moore, M. & Morris, F. Stress and Chronic Illness: the Case of Diabetes. J Adult Dev 18, 70–80 (2011). https://doi.org/10.1007/s10804-010-9118-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10804-010-9118-3

Keywords

Navigation