How Stress Affects Diabetes Mellitus Patients?

According to the World Health Organization (WHO), diabetes mellitus (DM) is a chronic metabolic disease that is characterized by inadequate control of blood sugar levels. Over time, it can lead to damage to some tissues. There are two types of diabetes: insulin-dependent (juvenile diabetes), in which the pancreas produces little or no insulin by itself, and the more common type 2 diabetes, which typically occurs in adults and is characterized by the body becoming resistant to insulin. While 422 million people worldwide have diabetes, the vast majority live in low- and middle-income countries. Both types have similar symptoms, including constant hunger, thirst, frequent urination, and fatigue. Although type 1 diabetes currently cannot be prevented, type 2 diabetes may be prevented with effective approaches. Like many other diseases, early diagnosis is crucial. Some symptoms can occur suddenly, making it difficult to be aware of the disease. People may not become aware of their condition until a few years later1.

Diabetes is a chronic disease that has both negative psychological and physical effects. While people often focus on the physical side, the psychological aspect is also important and can produce a paradoxical effect. Diabetes patients may feel useless, depressed, and stressed, which can indirectly weaken them2. Moreover, during this time, patients must strive to keep their blood sugar levels within the normal and healthy range.

Figure 1: It describes how diabetes takes place in the body1.

It is well-known that millions of people suffer from diabetes and millions more are at risk of developing the condition. Health organizations and individuals alike should focus more attention on this topic. It is crucial to regularly monitor and control blood sugar levels and strive to keep them within a healthy range for patients. Failure to do so can result in various complications, including blindness, chronic kidney failure, and more3.

There is a strong relationship between diabetes mellitus and stress. While this stress is often experienced by urbanites, currently, being a stressed person has become the norm for people all over the world. The general environment, including an unhealthy lifestyle, rapidly changing technology, trying to keep up with the news, and striving to be a social, hard-working, well-rested person, are all contributing factors. This is especially difficult for DM patients, as stress can interfere with blood sugar levels and disrupt the balance of hormones in an undesirable manner. Stress is not only related to diabetes, but also contributes to other diseases such as hypertension, cancer, skin diseases, and many more4.

Figure 2: An illustration related to the diabetes2

Complying with management rules to keep blood sugar levels in a healthy range can be a stressor for DM patients, but such compliance is an indicator of successful treatment. To manage type 2 DM, Acceptance and Commitment Therapy (ACT) is a common Cognitive Behavioral Therapy (CBT) method that is effective in addressing psychological aspects5. It is often used in quasi-experimental studies, which include an intervention and a control group. It supports the four pillars of diabetes management, including diet, regular exercise, providing health education, and taking medication6.

Recent research has investigated whether Acceptance and Commitment Therapy (ACT) has an influence on the management of type 2 diabetes. The results of the study showed that ACT increases compliance with the four recommended management strategies and improves adherence to type 2 diabetes management7.

Table: This table illustrates the relationship between stress levels and blood sugar levels. According to the research, there are 45 patients, 22 of them experience no stress and have hypoglycemia or normal sugar levels; 9 of them experience mild stress and have hyperglycemia; 11 of them experience moderate stress and have hyperglycemia; 3 of them experience severe stress have hyperglycemia4.

The study mentioned above showed that most of the patients belonged to the non-stressed category. Patients’ age, sex, education level, and length of suffering from DM should be taken into consideration. Almost 53% of the patients had been suffering from type 2 diabetes for 1-5 years, and in that group, they had lower stress levels because they were accustomed to the therapy being administered. Furthermore, as the education level increases, the knowledge to cope with stress also increases, which leads to a decrease in stress levels4.

In another study, researchers used “Guided Imagery Therapy” to reduce anxiety levels in patients with type 2 diabetes. The data from this research also showed that patients who had mild anxiety before the therapy were able to decrease their anxiety levels thanks to this technique8.

So, that kind of treatment helps people who are struggling with both the psychological and physical impacts of DM. Besides the medication, people should be aware of the importance of these treatments. Psychological sides are as important as what is seen in the blood. It is both the cause and the result of many diseases. Even though it is hard to stay in a positive and stable mood forever, at least we can consider that side now.

References:

  1. World Health Organization (WHO) – Diabetes, Retrieved from: 23.46 17.03.2023. https://www.who.int/health-topics/diabetes#tab=tab_1
  2. Hidayah, N. (2017). Study of Anxiety Levels of Diabetes Mellitus Patients in Outpatient Clinic of Ngawi Purba Health Center, Ngawi Regency. e-Jounal Cakra Medika, 32-33.
  3. Rahmawati, A., & Hargono, A. (2018). Dominant Factors of Diabetic Neuropathy in Patients with Type 2  Diabetes  JBE, 6(1), 61–68
  4. Susanti, S., & Bistara, D. N. (2022). RELATIONSHIP BETWEEN STRESS LEVEL AND INCREASED BLOOD SUGAR LEVELS IN PATIENTS WITH DIABETES MELLITUS. Jurnal Keperawatan Respati Yogyakarta, 9(3), 181-186.
  5. Hayes, S. (2010). Acceptance and commitment therapy: In Cognitive Behavioral Therapy in Clinical Practice. New York: The Guilford Press
  6. Purba, CI (2008) Experience of Disobedience of Patients Against Management of Diabetes Millitus (Phenomenological Study in the context of nursing care at Dr. Cipto Mangunkusumo Hospital, Jakarta). Depok: Thesis
  7. Bistara, DN,    Rusdianingseh,        2020. Acceptance    and    Commitment    Therapy (ACT) on Increasing  The  Compliance  of Management   Diabetes   Mellitus   Type   2. 2020. International Journal of Psychosocial Rehabilitation 24 (9), p: 942-946
  8. Susanti, S., & Ristyawati, R. N. I. (2021). THE EFFECT OF THERAPY GUIDED IMAGERY ON THE LEVEL OF ANXIETY IN PATIENTS OF TYPE 2 DIABETES MELLITUS. Nurse and Holistic Care, 1(1), 14-22.

Figure References:

  1. https://byjus.com/biology/diabetes-mellitus/ BYJU’S Biology – Diabetes Mellitus, Retrieved from 11.43 – 18.03.2023.
  2. https://endo-society.org.ph/type-2-diabetes-mellitus/ Philippine College of Endocrinology – Diabetes and Metabolism,  Retrieved from 18.36 – 18.03.23.

Inspector: Nadir KERESTECİ 

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