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The Link between Stress and diabetes: a tangled affair

August 10, 2012
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More than 200 years before doctors first pioneered the treatment of insulin for diabetes, an English physician described the disease as being caused by “sadness or prolonged sorrow”.

It is a claim that has intrigued researchers who have sought to find out if a link exists between depression or stressful events and the triggering of diabetes, and fuelled by research in Sweden that seems to show a strong relationship between “mental duress and diabetes-related autoimmune activity”.

But scientists say that while stress and diabetes are entangled, the relationship between the two is complex.

Jane Speight, foundation director of the Australian Centre for Behavioural Research in Diabetes, says diabetes can lead to stress and it could possibly contribute to the development of diabetes.

But diabetes also leads to “distress” which is different again.

“We know that diabetes can cause distress in people and there is a lot of research around diabetes-related distress, which is the distress caused by the continual fear of the patient developing problems in the future or the day-to-day management of diabetes,” Professor Speight says. “That distress can be severe and it can lead to depression in some people.

“But stress is a different thing: the stress in people’s lives may affect their diabetes but that perception is very individual. Some people cope very well with stress and some people don’t cope well at all. It is not so much the stressor itself but it is the type of coping mechanism that influences the outcome.”

Determining whether stress is a contributing factor to developing diabetes in the first place is also complex.

There is some evidence that long-term stress plays a role in the development of type 2 diabetes but the relationship is less clear for type 1.

In 2005, a large-scale Swedish study claimed to have found evidence linking the development of type 1 to mental stress, after studying almost 6000 children born between 1997 and 1999 and their parents and then checking the children’s blood for two types of antibodies that occur in pre-stages of type 1 diabetes. The parents also completed a questionnaire three times indicating life events that could be considered stressful.

The researchers found a correlation between the presence of the antibodies and high levels of stress among the parents – which was presumed also to affect the children.

Children whose parents had divorced or whose mothers had experienced violence had three times the risk of having the antibodies related to diabetes. However, the most common stress factors were having a mother or father who had difficulty sleeping or who were not content with being a parent.

Professor Speight says it is too early to say whether the link between stress and type 1 is sufficiently strong.

“In terms of the onset of diabetes and whether stress can cause that, the jury is still out,” she says.

“There are various studies that are looking at the events that occur before people develop type 1 diabetes and if you ask people what they think caused the change in their body’s ability to deal with glucose, many people will attribute it to some sort of life stress at the time or shortly before that.

“There is some evidence that may be true but it is still unclear what that mechanism might be.”

For Type 2, the link is much stronger.

“There is some reasonable evidence that long-term stress may play a role in the onset of type 2 and there was a good review paper last year that showed that different emotional stress is associated with an increased risk of developing type 2 diabetes, and this included depression, anxiety and sleeping problems,” Professor Speight says.

“There did seem to be some evidence for childhood trauma or trauma at an early stage being linked to type 2 diabetes later in life but all of those studies were quite limited in their design.”

Complicating the issue is trying to tease apart the idea of stress and other confounding factors. A person with a high-stress job may develop diabetes but their stressful job may also have led to poor eating habits and sedentary behaviour – both well-recognised risk factors.

“It is really why the studies haven’t been done so far – they would be incredibly complex, would need to be run over many years and would be very expensive,” Professor Speight says.

“Some people do well with stress and cope with proactive ways, some people are problem solvers, some people go into denial or have other strategies that are not particularly well adapted.”

For a person with diabetes already, stress can make it harder to manage the disease – the reason Diabetes WA has nominated stress management as its theme for this year’s Diabetes Week.

Professor Speight says for some people with diabetes, stress will increase blood glucose levels while it will cause them to fall in other people.

“The most important thing that someone can do if they have diabetes and they think stress might be a problem in their lives is to identify their stress reactions,” she says.

“It is really important to work out which one you experience so you can cope with that and take action accordingly.”

She advises anyone – diabetic or not – to eliminate some of the things that lead to stress in their lives.

“Particularly if you have type 1 diabetes it is important to make sure you are safe and you are not ending up in a ‘hypo’ because your blood sugar levels are plummeting because of stress and you are not aware of it,” she says.

“Try to incorporate relaxation into your routine and catch up on hobbies and sleep. Get exercise and garner the support of your family, friends and colleagues to deal with the stress and reduce it.”

Diabetes WA has educators who can help people with diabetes assess if they are stressed and what form of stress they are experiencing. They can then help the person develop a strategy to respond and resolve that stress. For advice, see diabeteswa.com.au.

Article source: http://au.news.yahoo.com/thewest/lifestyle/a/-/lifestyle/14209382/stress-and-diabetes-a-tangled-affair/

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