Diabetes Health Center

Depression a Big Obstacle to Self-Help in Diabetics.

Oct. 27, 1999 (Atlanta) -- Biofeedback can help diabetics maintain good control of their blood sugar during times of stress. However, when depression and anxiety are present, practicing the self-management technique is not enough for patients to get a handle on their stress and concentrate on controlling their blood sugar.

Researchers at the Medical College of Ohio in Toledo say doctors can throw all the helpful suggestions they want at diabetic patients -- such as recommending exercise and relaxation -- but if the patients are depressed, anxious, or feeling hassled, they may not comply. Biofeedback consists of various relaxation exercises designed to control the body's response to stress.

What makes the study so potentially important is the high prevalence of depression among diabetics, says researcher Angele McGrady, PhD, a psychology professor at the Medical College. "Depression has a significant effect on the severity and worsening of diabetes," she says. "Any behavioral modification they have to make -- where they have to do something -- if they're depressed, they won't do it."

"Diabetic treatment is very complex and requires a number of steps," says Alan Jacobson, MD, a senior vice-president at the Joslin Diabetes Center in Boston and professor of psychiatry at Harvard Medical School. "It really requires you to do the work." Put feelings of pessimism and hopelessness into the mix and blood sugar management can really suffer, he says.

Jacobson likens trying to manage diabetes when feeling troubled or depressed to studying for a chemistry or physics exam after a romantic relationship has ended.

McGrady, who characterizes diabetes as a "behaviorally intense" disease, says it's important to offer opportunities and techniques for self-management, to give patients a sense of control. Proper control of diabetes and maintaining a healthy lifestyle can be disrupted by stressful life events. Biofeedback and relaxation exercises, which some research has linked to a lowering of blood sugar levels, are two examples of ways that patients can manage stress and maintain a good control of their diabetes.

"The original concept of biofeedback is a biological one," says Jacobson. "There were a series of observations made, and then refuted, that you could in a lab setting introduce stress, and it would lead to shifting of blood sugars."

Relaxation, then, might work to lower blood sugar levels -- a concept that seemed to hold in two previous studies in which McGrady was involved. "The patients trained to biofeedback had significant reductions in blood glucose levels," she says. "Their insulin levels stayed the same, but they had better control of their diabetes."

But that was not necessarily the case with this latest study, the results of which were published in a recent issue of Applied Psychophysiology and Biofeedback. Researchers found "treatment failures" among those trained in biofeedback and relaxation. McGrady noticed a trend, based on psychological questionnaires these patients had filled out. "The subjects who were treatment failures also were depressed, anxious, and took longer to complete the program," she says. "So what we think now is that mood has an important impact on biofeedback."

This doesn't surprise Jacobson. "We and others have found that patients with a history of depressive disorders have worse [control of their diabetes]."

McGrady says the bottom line to her study is that diabetic patients should be screened for depression and anxiety -- and if symptomatic, treated "before sending them off to biofeedback or exercise."

She and her colleagues plan to test that theory in the next study, to see whether antidepressant medications can motivate diabetics to incorporate biofeedback and relaxation into their treatment regimen.