Stress Management of Diabetic Patients: An empirical study


By

Ms. Sapna Malviya
Sr. Asst. Professor
Modern Institute of Pharmaceutical Sciences
Indore

Dr. Punit K. Dwivedi
Sr. Asst. Professor
Modern Institute of Professional Studies
Indore
 


Overview: India is the diabetes capital of the world with 41 million Indians having diabetes; every fifth diabetic in the world is an Indian (Joshi, 2005). The goal of diabetes management is to reduce the oxidative stress and impart quality life to patient (Landsberg, et al., 1985). It is widely recognized that stress may have negative effects on health and that patients and is associated with the release of counter regulatory hormones and energy mobilization, often resulting in elevated blood glucose levels (Inui, et. al., 1988). The patients assess insulin as well as synthetic drugs showed significant therapeutic potential; their use has already been restricted due to several undesirable side effects such as hepatotoxicity, cardiomegaly and hemotoxicity (Davis, et, al., 2001).

Objective: In this study  our aim is to discuss new drug development and impact of herbal drugs for diabetic patient and their emerging opportunities for pharmaceutical industry.

To find out impact of herbal drugs on diabetic patients in Indore city,
To Evaluate Stress level of diabetic patients,
To manage stress level of patients suffering from Type 1 and Type 2 diabetes,
To ensure stress free life to diabetes patients,
To evaluate wide acceptance, preference of herbal drugs., To evaluate awareness level of herbal drugs among diabetic society.

Purpose of the Study:

The purpose of study is to know the social acceptance of Acacia nilotica Linn (Synonym: Babul) belonging to family Leguminoseae and impact of the same for management of Stress level of Diabetic patient from the . The aim of the present investigation is to determine whether a cost-effective, group-based stress management by herbs can improve glucose metabolism in patients with diabetes and to determine whether a particular subset of patients is more likely to get positive results.

Literature Survey:

Attari et al, 2006 had evaluated stress management training on glycemic control in patients with type 1 diabetes. The participants were 60 type 1 diabetic patients (aged 16-30). 30 Subjects attended in 3-month stress management training classes during which the prescribed insulin remained constant, but the remainder 30 ones did not. HbA1 from all patients were measured before and after the intervention. "Trained patients showed significantly improved ways of coping. HbA1 changed from 11.7(plusminus)2.9 and 10.9(plusminus)2.1 before training to 8.5(plusminus)1.7 and 10.3 (plusminus)2.1 after intervention in trained and control groups respectively and the changes were significant in study group (p<0.001). In addition, the difference between means of HbA1 of two groups was statistically significant at the end of the study (p<0.001),"

Attari and colleagues published their study in Diabetes Research and Clinical Practice (Effect of stress management training on glycemic control in patients with type 1 diabetes. Diabetes Res Clin Pract, 2006;73(1):23-28).

Diabetes is the most serious endocrine syndrome and is becoming the third killer disease of mankind, till now Diabetes Cannot be cured, only it can be prevented by maintaining diet and life style. Diabetes mellitus is a metabolic disorder characterized by hyperglycemia, glycosuria, negative nitrogen balance sometime ketonemia resulting either inadequate secretion of insulin, an inadequate response of target cells to insulin, or combination of these factors. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body. After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach. When we eat, the pancreas is supposed to automatically produce the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced (Viner, et. al., 1996). Glucose builds up in the blood, overflows into the urine, and passes out of the body. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose (Surwit , et. al., 1993).

The side effects from oral antidiabetic agents include pruritus, erythema multiform, erythema nodosum, urticaria, morbilliform rash, lichenoid eruptions, and photo sensitivity. The patient using an insulin pump can experience local infections at the site of needle insertion, allergy to tape and tubing materials, and rarely hard subcutaneous nodules. The need of today's world is to explore Indian medicinal plants for management of diabetes mellitus and side effects associated with the administration of oral hypoglycemic agents. The World Health Organization (WHO) estimates that 4 billion people, 80 percent of the world population, presently use herbal medicine for some aspect of primary health care. Approximately 4% population worldwide suffering from diabetes is expected to increase by 5.4% in 2025.

Stress is a part and parcel of modern day life. Diabetes may be an outcome of stress and further sets in a vicious cycle of stress-diabetes relationship. Stress coping mechanisms are many and it depends on resources available with a wide range of personal variations. There is no evidence that stress causes diabetes. However, Stress hormones that are designed to deal with short-term danger stay turned on for a long time. As a result, long-term stress can cause long-term high blood sugar levels. Many long-term sources of stress are mental. Physical stress, such as illness or injury, causes higher blood glucose levels in people with either Type of diabetes. Stress blocks the body from releasing insulin in people with Type 2 diabetes. The diagnosis of diabetes usually comes as a shock and is certainly a stressful time (Wijenaike, 2002; ADA, 2007). Changes in lifestyle including stoppage of smocking, diet and learning to manage injections may all contribute in addition to the worry regarding chronic illness (Davis et al., 1999). In people who have diabetes, stress can alter blood sugar levels. It does this in two ways. First, people under stress may not take good care of themselves. People who are anxious are under pressures and may lose appetite and skimp on eating, or reach for not-so healthy quick fixes like candy or chips and sometimes seek refuge in food and drink. This can take the form of chocolates, sweets and crisps, often in between meals. The intake of alcohol may be increased. Many people who are under stress turn to food as a source of 'comfort'. This pattern of 'comfort eating' can often play havoc with blood sugar level. Further anxiety leads to less exercise. The results can be disastrous for people with diabetes. They may forget, or not have time, to check their sugar levels or plan good meals. Second, stress hormones may also alter blood sugar levels directly as it antagonizes the action of insulin. While in most people glucose levels go up with mental stress, while in others can go down. (ADA, 2007).

Discussion:

The present investigation is to determine whether a cost-effective, group-based stress management training program can improve glucose metabolism in patients with type 2 diabetes and to determine whether a particular subset of patients is more likely to get positive results. Patients with type 2 diabetes were randomized to undergo a five-session group diabetes education program with or without stress management training. Participants (n = 108) were followed for 1 year, during which HbA(1c) tests and questionnaires assessing perceived stress, anxiety, and psychological health were administered at regular intervals to evaluate treatment effects. Stress management training was associated with a small (0.5%) but significant reduction in HbA(1c). The current results indicate that a cost-effective, group stress management program in a "real-world" setting can result in clinically significant benefits for patients with type 2 diabetes.

The population is growing and aging; new areas of medical need are emerging; and the diseases from which people in developing countries suffer are increasingly like those that tribal people living in the developed world. These changes will generate some huge opportunities for Herbal medicines. The present project proposal explores various opportunities generating for herbs and their isolated product in treatment of life threatening disease of diabetes.

Bibliography

1.  Joshi, S.R. (2005) "Management of Obese Indian Patient", Indian Journal of Obesity, I (1), (pp. 11-20).

2.  Surwit R.S. and Schneider M.S: (1993) "Role of stress in the etiology and treatment of diabetes mellitus". Psychosom Med, 55, (pp. 380393).

3.  Viner R, McGrath M and Trudinger P. (1996) "Family stress and metabolic control in diabetes", Arch Dis Child, 74: (pp. 418421).

4.  Landsberg L and Young J.B. (1985) "Sympathoadrenal system: the regulation of metabolism", Contemporary Endocrinology, Vol. 2, Ingbar SH, Ed. New York, Plenum, (pp. 217246).

5.  Inui A, Kitaoka H, Majima M, Majima M, Takamiya S, Uemoto M, Yonenaga C, Honda M, Shirakawa K, Ueno N, Amano K, Morita S, Kawara A, Yokono K, Kasuga M and Taniguchi H (1998) "Effect of the Kobe earth- quake on stress and glycemic control in patients with diabetes mellitus". Arch In- tern Med 158, (pp. 274288).

6.  Rubin RR and Peyrot M (1999) "Quality of life and diabetes". Diabetes Metab Res Rev,  15, (pp. 205-218).

7.  Davis TM, Clifford RM and Davis WA (2001), Effect of Insulin therapy on quality of life in type 2 diabetes mellitus:The Fremantle Diabetes Study, Diabetes Res Clin Pract, (pp. 52:63).

8. Wijenaike, Nishan. Official Home Page of Diabete Suffolk. com.   23rd  November 2002. "Diabetes and Stress". Retrieved on 22. 3. 2007 from http://www. diabetesuffolk.com.

9. American Diabetes Association. Official Home Page of American Diabetes Association. 2007. How Stress Affects Diabetes. Retrieved on 14. 2. 2007 from http://www.diabetes.org/type-1-diabetes/stress.jsp.

10. Davis, R. M., E. H. Wagner and T. Groves. 1999."Management of Chronic Diseases."  British MedicalJournal,  318: 1090-1.
 


Ms. Sapna Malviya
Sr. Asst. Professor
Modern Institute of Pharmaceutical Sciences
Indore

Dr. Punit K. Dwivedi
Sr. Asst. Professor
Modern Institute of Professional Studies
Indore
 

Source: E-mail April 10, 2011

          

Articles No. 1-99 / Articles No. 100-199 / Articles No. 200-299 / Articles No. 300-399 / Articles No. 400-499/ Articles No. 500-599
Articles No. 600-699 / Articles No. 700-799 / Articles No. 800-899 / Articles No. 900-1000 / Articles No. 1001-1100
Articles No. 1101-1200 / Articles No. 1201-1300 / Articles No. 1301 Onward / Faculty Column Main Page