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I recently ran across this article on Diabetes Hub which describes two important studies which correlate distress with poorer outcomes for people coping with diabetes. The first of these studies involved a randomized trial of 150 women with uncontrolled diabetes. What the study found is that those women in the study who were able to reduce their level of disease-related distress had significantly improved glycemic control.
Typical sources of disease related distress included fear of getting sicker and feelings of isolation or overwhelm in relation to disease management and treatment. The EMPOWER study tested various forms of treatment interventions and found that regardless of treatment methodology, those people who were able to lower their distress were more compliant with treatment protocols:
HbA1c dropped much more substantially in those in whom distress was lowered, compared to those with whom distress was unchanged or increased,” Dr. Cummings said. “Medication adherence, self-care behaviors, and diabetes empowerment and self-efficacy were all substantially improved in the group with lower levels of distress at the end of the trial.
The doctors admit that they don’t quite know why lowering distress has such a significant effect on glycemic control among people with diabetes. However it seems that working to lower distress among people with the disease is an important treatment goal. According to Dr. Cummings:
We’re surprised at the number of these women caring for children, grandchildren, and other members of their families, often while working, and yet not finding time to care for themselves. It is clearly an important cultural phenomenon that we need to understand better.
The article went on to discuss data gathered from another important study: the national Reasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study. Dr. Cummings noted that in this study which included 4,000 black and white adults 45 years and older with diabetes and nearly 18,000 adults without diabetes, those subjects with diabetes were more likely to suffer from depression or distress (26.7% vs. 23.2%, P < .001) or both (10.1% vs. 6.2%, P < .001), compared with those without diabetes. Those people who had diabetes and also symptoms of distress or depression had higher risks for stroke and CV death than people with diabetes without depression or distress.
What all of this seems to make clear to me is the deep need for compassionate, blame-free, stigma-free, evidence-based health care for people coping with diabetes. The notion of scaring people straight or using dire warnings to fuel completely unrealistic weight loss goals may be more than counterproductive–they might prove especially medically dangerous for this population. Many forums for people with diabetes are filled with horror stories about how members were stigmatized, told their conditions were their fault and told that if they didn’t get thin, they wouldn’t live to see their children or grandchildren grow up.
But maybe what really needs to grow up is our approach to helping people with diabetes live better, longer and happier lives. Maybe we need to spend a little less time pointing fingers and a little more time holding hands as we help people make small, incremental, manageable and realistic changes in their lives. It’s just possible that fear tactics are doing more to harm people with diabetes than to help them.
That’s one of the reasons I’m so excited to be giving a presentation at the upcoming Take Control Of Your Diabetes Conference on September 26 in San Diego, CA The event focuses on helping people with diabetes take positive, small and sustainable steps to better health.
Kind of makes sense though – lowered stress = lowered cortisol and I think that lowers all sorts of bad stuff. But beyond that, when you’re not being stressed and lectured to, you have time to plan, to take better care of yourself, to eat better, to breathe, to walk, to just enjoy the day. I just hope that lots of people read this and take note. Thank you!
Yup. The cortisol connection came to my mind as well. Seems like a good place for research to happen.
Thanks for this. The “fat = diabetic = your own fault” is so damaging, stigmatizing, and just nonsensical. It’s maddening.The doctor I recently saw (who I refuse to consider “my” doctor, because that’s a huge stretch) said my number is still prediabetic, but that he would just call that diabetes and often prescribes Metformin. Said doctor also recommended WLS and WL medication, though, so I really don’t trust his medical advice. I know part of my resistance to being considered “diabetic” rather than “prediabetic” is because of the stigma assigned to being a fat person with diabetes. I also hate to take and pay for a medication that I might not even need or benefit from.
I think it’s reasonable to not want to take medication for a condition you don’t have. There’s a number of people out there who dispute the value of “prediabetic fear mongering”. And what is his justification for just calling pre-diabetes diabetes other than to scare you into what he considers some sort of compliance. And there is a lot of confusion out there about weight and compliance. If you ask a patient to engage in an evidence-backed behavior to improve health and the patient is physically, emotionally and economically able to do that behavior and they chose not to, you might have a case to make about compliance. There is no evidence that dieting over the long term makes people healthier, happier or thinner. There is lots of evidence that shaming and stigmatizing people makes them less happy, less healthy, and on average, gain weight. And furthermore, body size is not a behavior. If I had a dollar for every doctor who automatically believes that their fat patients are not compliant, I would be a very, very wealthy woman.