Biofeedback to the rescue for diabetics

1/23/2006

Relax, you'll feel better.

For diabetics, this is more than just a saying. It could be lifesaving.

A small study at the Medical University of Ohio published in a recent issue of the medical journal, Diabetes Care, demonstrated that diabetics can lower blood sugar levels by relaxing.

The study found that people who learned to relax through biofeedback lowered their blood glucose levels by an average 0.8 points. A control group, who attended three diabetes education classes, but learned no relaxation technique, saw blood sugar increase slightly, by about 0.2 points.

The MUO study lends further support to a growing body of research that shows the importance of emotion in managing diabetes, a chronic disease that is rapidly increasing in incidence in the United States. Nearly 21 million Americans, or 7 percent of the population, have the disease.

Although at least one study failed to show a connection between relaxation and glucose levels, other studies have been more suggestive. Research published in 1992 involving 108 people with type 2 diabetes showed a small but significant decrease in blood sugar for participants who attended stress-management classes. A study in 1999 looked at type 1 diabetes and saw similar success for relaxation. Like the MUO test subjects, these patients used a relaxation training method known as biofeedback.

"We actually hook them to a machine that helps them get feedback like their heart rate, their muscle tension, their skin temperature, and what they learn to do is change these things through relaxation,'' said Dr. Ronald A. McGinnis, lead author on the MUO study.

Why would relaxation play a role in blood-sugar levels?

When you're under stress, whether it's from that accidental turn into the grill of a racing garbage truck, or it's delivered via the aggressive ranting of a boss, your body sends out hormones to help you meet the perceived threat. Adrenaline and cortisol come rushing from the adrenal glands, signaling your body to keep glucose in the blood stream.

All this sugar in the blood creates a constellation of risks if not brought under control. In the kidneys, tiny blood vessels can clog, which may lead to dangerously high blood pressure, an increased risk for heart disease, kidney damage, and stroke. High glucose levels can mar circulation in the eyes, and cause blindness. It can impair nerve sensitivity in arms and legs, and lead to untreated injuries and amputations.

"Stress can put somebody in the hospital. It can uncover diabetes, and it can absolutely worsen diabetes,'' said Dr. Gregory Tennyson, an endocrinologist who treats diabetes at MUO.

So for diabetics, controlling sugar in the blood stream is a life-saving need.

The MUO study also hinted at another emotion important in the management of diabetes: depression.

"If you have depression, you're more likely to drop out of treatment,'' Dr. McGinnis said. Thirty-nine people were originally enrolled in the MUO study, but nine quit. Of those, seven were rated depressed by a test each study participant completed. Among the 30 who completed the study, the proportion of depressed patients was lower: 12 had test scores that suggested they were depressed. All study participants were offered antidepressant therapy before beginning the research.

"Diabetics should be screened for depression and aggressively treated,'' Dr. McGinnis said. "A lot of studies show people with depression have worse outcomes. They're not motivated. They're overcome by hopelessness and helplessness. They can't follow a diet, take their medicine, or exercise regularly.''

"Depression is a big issue, and very often it's not addressed by physicians. People are often belittled,'' said Cecilia Sauter, director of the diabetes education program at the University of Michigan Comprehensive Diabetes Center.

"It is important that a patient sits down with the physician and says, 'This is harder to deal with than I thought... This feels very overwhelming,' '' Ms. Sauter said.

Depression also raises cortisol levels, Dr. Tennyson said.

In the past, doctors used guilt to try to motivate diabetic patients to lose weight, exercise more, and stay on top of blood sugar levels. It was a losing strategy.

"The modern diabetologist tries immediately to move past this emotion of guilt,'' Dr. Tennyson said. Telling a depressed, stressed patient to pull himself together was an "absolute failure.''

Today physicians try to "help patients get off the hook about feeling guilty about their stress and blood sugar control. It's not your fault your blood sugar control has deteriorated. This is a consequence of stress, not something you caused. Just that recognition can help.''

Contact Jenni Laidman at: jenni@theblade.com or 419-724-6507.