Life experience critical for managing Type 2 diabetes

"We found we can evaluate a patient's initial stress and predict how they will be doing six months later," said Vicki Helgeson, professor of psychology at CMU's Dietrich College of Humanities and Social Sciences and senior author on the paper. "If you can identify people who are facing diabetes distress earlier, you can intervene and prevent their health from declining."

The results are available in Nov. 15 issue of the Journal of Behavioral Medicine.

Currently about 27 million people in the United States live with Type 2 diabetes. Past research has shown that stress associated with diabetes management leads to poor blood sugar control.

In the study, the team evaluated 207 patients (55% male, 53% white, 47% black, 25-82 years of age), who were diagnosed with Type 2 diabetes within the past two years. They used several surveys to evaluate health, psychological distress and health care, as well as studied the participants' daily dairies to identify stressors. The researchers assessed patients at the start of the study to establish a baseline and then six months later. They examined the results with regard to gender, race/ethnicity, age, education, employment, income, relationship status and use of medication.

They found younger patients (42 years and younger) experienced higher diabetes-related and psychological distress. In addition, patients with higher education and income expressed more stress. Conversely, older patients (older than 64 years) had less psychological stress and greater consistency in self-care, blood sugar control and medication adherence. Patients in long-term relationships also reported less diabetes stress.

"This is a diverse sample with respect to age, education and race, which makes the result even more provocative," Helgeson said. "We do not know in an objective way if patients with a higher income have more stressors, but they perceive they have more stress."

Patients identified diet as the greatest stressor (38%). Other significant stressors include checking blood sugar (8%) and experiencing high or low blood sugar events (7%). Patients who self-reported greater stress also reported greater depressed mood, less adherence to medication and higher anxiety.

"Diabetes care is difficult, because it requires a lifestyle change that you have to do forever," Helgeson said. "Life gets in the way of sticking to a diabetes regimen."

While the study was not designed to explore why patients handle stressors differently, Helgeson believes older adults may live in the present compared to younger adults, whose focus on the future may magnify their stressors. Diabetes is also more common as people age, and older patients may find more support from their peer group. She also suggests older adults may leverage past experiences to employ emotion regulation strategies to mitigate the stress associated with managing the disease.

After a diagnosis, many patients experience stress as they modify their lifestyle to accommodate diet, weight control, medication and exercise routines, which can be time-consuming, complicated and costly. Complications from diabetes include heart disease, stroke, kidney disease and lower limb amputations.

Helgeson notes that the study was not designed to interpret the cause of underlying stressors or identify emotion regulation strategies. In addition, the daily stress measure was not developed to expand on the nature of the stressor. Future studies could evaluate how patients react to stressors to develop effective intervention and regulation strategies for different age, gender, and cultural groups.