Group-based stress management training benefits type 2 diabetics

NEW YORK (Reuters Health) – Duke University researchers have demonstrated, for the first time, that a group-based approach to stress management training can improve long-term glycemic control in type 2 diabetics. This method is more cost-effective than individualized biofeedback-assisted training, they note.

The program involved five weekly small-group educational sessions on diabetes care in general, progressive muscle relaxation, the use of cognitive and behavioral techniques to recognize and reduce stress levels, and education about the health consequences of stress, as Dr. Richard S. Surwit and colleagues explain in the January issue of Diabetes Care.

The researchers recruited 108 type 2 diabetics who did not currently require insulin. The subjects were randomized to the stress management program or to five sessions of general diabetes education.

Thirty-eight subjects in the active treatment group and 34 controls completed the treatment phase and 12 months of follow-up. At the end of the study, the subjects trained in stress management showed a 0.5% reduction in HbA1c compared with controls, the Durham, North Carolina researchers report.

"Although this change was modest, improvements of <0.5% in HbA1c have been associated with a significant reduction in risk of microvascular complications," they point out. Furthermore, they say, at the 12-month follow-up 32% of the subjects trained in stress management showed at least a 1% reduction in HbA1c from baseline, versus only 12% of controls.

"I believe that community-based physicians can adopt this program, especially if they have access to a diabetes educator who can be trained in the techniques," Dr. Surwit told Reuters Health. "The problem is that insurance often doesn't pay for diabetes education."

Dr. Surwit added that he and his group plan to develop a self-training package about stress management "that would be inexpensive and available to all without the need for further professional intervention." They plan to submit another grant application to the National Institutes of Health, which funded this study, for a study to determine that a self-help program is effective.

In order to see whether stress management training will help a diabetic patient who has adverse metabolic control, physicians can prescribe a brief course of an anxiolytic, Dr. Surwit suggested. "We have previously shown that there is a strong correlation [in diabetics] between response to benzodiazepines and response to stress-management training."

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