Surwit Richard S, van Tilburg Miranda A L, Zucker Nancy, McCaskill Cynthia C, Parekh Priti, Feinglos Mark N, Edwards Christopher L, Williams Paula, Lane James D
Duke University Medical Center, Durham, North Carolina 27710, USA.
Diabetes Care. 2002 Jan;25(1):30-4. doi: 10.2337/diacare.25.1.30.
There is conflicting evidence regarding the utility of stress management training in the treatment of diabetes. The few studies that have shown a therapeutic effect of stress management have used time-intensive individual therapy. Unfortunately, widespread use of such interventions is not practical. The aim of 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). Compliance with the treatment regimen decreased over time but was similar to that seen in patients receiving stress management for other reasons in the clinic. Trait anxiety (a measure of stable individual differences in anxiety proneness) did not predict response to treatment, showing that highly anxious patients did not derive more benefit from training.
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.
关于压力管理训练在糖尿病治疗中的效用，证据存在冲突。少数显示压力管理有治疗效果的研究采用了耗时的个体治疗。不幸的是，广泛使用此类干预并不实际。本研究的目的是确定一个具有成本效益的、基于小组的压力管理训练项目是否能改善2型糖尿病患者的糖代谢，以及确定是否有特定亚组的患者更有可能获得积极结果。
2型糖尿病患者被随机分为接受为期五节的小组糖尿病教育项目，其中一组有压力管理训练，另一组没有。对108名参与者进行了1年的随访，在此期间定期进行糖化血红蛋白（HbA1c）检测以及评估感知压力、焦虑和心理健康的问卷调查，以评估治疗效果。
压力管理训练与糖化血红蛋白（HbA1c）小幅（0.5%）但显著的降低相关。对治疗方案的依从性随时间下降，但与临床中因其他原因接受压力管理的患者相似。特质焦虑（一种衡量焦虑倾向稳定个体差异的指标）并不能预测对治疗的反应，表明高度焦虑的患者并未从训练中获得更多益处。
目前的结果表明，在“现实世界”环境中开展的具有成本效益的小组压力管理项目可为2型糖尿病患者带来临床上显著的益处。
