New research finds that in non-insulin dependent (Type 2) diabetes the body's own insulin secretion may automatically compensate, at least partially, for short-term fluctuations in blood sugar whether triggered by psychological or behavioral events. In contrast, blood sugar control in insulin dependent (Type 1) diabetes is more subject to such fluctuations since the body cannot compensate automatically.
Treatment of persons with diabetes should take into account the stress and coping measures that influence directly their body's regulation of blood sugar and also affect their compliance with their biological regime of insulin, blood tests and diet.
"Our study moves a step beyond earlier research by developing a biopsychosocial model that reflects not only the interplay among psychosocial factors but also the way in which they combine and interact with biological factors in diabetes control," said Mark Peyrot, PhD, of Loyola College Center for Social and Community Research in Baltimore. Peyrot and his colleagues report the results of their study on diabetes control in the June issue of The Journal of Health and Social Behavior.
The findings of the study support three central elements of the biopsychosocial model of diabetic control, namely:
- The relationships of stress, coping and adherence to regime are intertwined.
- Biological factors interact with psychosocial factors in affecting control of
blood sugar.
- The relationships with psychological factors are different for chronic and transitory blood sugar control.
In Type 1 the pancreas loses its ability to produce insulin, resulting in uncontrolled surges in blood sugar. Coma may result, followed by death unless emergency medical intervention is provided. In Type 2, cell tissues are resistant to the action of insulin, and insulin levels increase to compensate for this resistance until, eventually, insulin production lags behind the body's demands.
The participants' stress and coping were measured by a "hassle scale" and a coping style questionnaire, and their background histories were taken. Compliance with treatment regimen was measured by a series of items such as "number of days last week you were late for insulin or late for a meal."
Modern diabetes care has the goal of maintaining blood glucose levels as near normal levels as possible. Persons with diabetes must consciously manage their sugar intake, insulin levels and energy expenditure to avoid high glucose levels (hyperglycemia). Their task is complicated by the risk that blood glucose levels can go too low (hypoglycemia) as a result of too much insulin, too much exercise or not enough food. Hypoglycemia can lead to delirium, unconsciousness and brain damage and death.
An estimated 15 million people in the United States have diabetes, approximately half of them undiagnosed.
The Journal of Health and Social Behavior is a peer-reviewed quarterly publication of the American Sociological Association. For information about the Journal, contact its editor, John Mirowsky, 614-688-8673.
Posted by the Center for the Advancement of Health http://www.cfah.org. For information about the Center, call Petrina Chong, pchong@cfah.org 202-387-2829.
Journal
Journal of Health and Social Behavior