For people with diabetes, controlling their blood sugar (glucose) is essential for staying healthy and avoiding complications of the disease, such as stroke, kidney disease, heart disease, nerve disorders, and retinopathy. Because stress is associated with the release of hormones that often result in elevated glucose levels, it has been proposed that stress reduction techniques may help control glucose levels. A recent study published in Diabetes Care suggests that stress management techniques can modestly reduce glucose levels in people with type 2 diabetes.

About the study

Researchers at Duke University Medical Center enrolled 108 men and women with diabetes, age 30 or older, into a 12-month study. All participants were currently managing their diabetes with diet, exercise, and/or oral medications.

People were excluded from the study if they currently took psychiatric or illicit drugs, were undergoing psychiatric treatment, took insulin, or were pregnant or lactating. In addition, people were excluded if they had prior relaxation or stress management training, had conditions that would prohibit safely donating blood for testing, or could not read and write in English.

The study participants were randomly assigned to attend five weekly sessions of either diabetes education classes plus stress management training (treatment group) or diabetes education classes only (control group). Diabetes education classes were 30-minute sessions that covered general diabetes information and healthy eating, but did not address specific strategies for glucose control. Stress management training consisted of progressive muscle relaxation training, skills to recognize and reduce stress levels, and information on the health consequences of stress. Both education and stress management classes were provided in the first two months of the study.

At 2, 4, 6, and 12 months, each participant's glucose was measured with an HbA1c test, which reflects average blood glucose levels over a period of two to three months. Along with each HbA1c test, participants answered questionnaires designed to measure their perceived stress, anxiety, and psychological health. In addition, they answered a general health questionnaire regarding weight, activity and diet—all factors that can affect glucose levels.

The findings

At the end of the one-year study period, the group who had received stress management training (treatment group) had experienced a 0.5% reduction in their HbA1c scores. Thirty-two percent of people in the treatment group had HbA1c scores that were lower by 1% or more, versus only 12% of the controls who experienced this level of reduction. Between month 6 and month 12, glucose levels of controls were rising while glucose levels in the treatment group were falling.

Researchers analyzed the information on diet, weight and activity, and found that neither diet nor physical activity changed in a way that could have produced the reduction in glucose levels.

A reduction of 0.5% to 1.0% may seem small, but it is important because reductions of this magnitude have been associated with reduced risk of microvascular complications—a common concern for people with diabetes.

There are several limitations to this study. First, information on how often members of the treatment group actually used the stress management techniques was self-reported by the participants. In the end, 72 of the 108 participants completed the study—a total of 67%. More people in the treatment group dropped out of the study than in the control group.

How does this affect you?

Previous research on the effects of stress management on glucose levels has produced mixed results. Some studies that have shown positive effects on glucose levels have employed more intensive, one-on-one therapy than the outpatient group sessions used in this study. Individualized inpatient therapy can be expensive and may not be feasible for many people. This study provides helpful information about the effectiveness of more affordable and convenient group outpatient sessions that teach people to do the techniques on their own.

Stress may also disrupt diabetes control through its effects on diet, exercise, and other diabetes self-care measures. So reducing stress may help address these factors, as well.

Should you begin learning stress management techniques if you have diabetes? Will it help control your glucose levels? Maybe. But, regardless of glucose levels, stress reduction is generally not a bad idea. Some medical literature suggests that stress can reduce your body's ability to fight off infection and illness, and increase your risk of high blood pressure, stroke, heart disease, ulcers, and more. These are all good reasons to control your stress levels, whether you have diabetes or not.