Perceived stress and diabetes control in adolescents.

Studies of diabetes control have traditionally focused on patients' regulation of insulin, diet, and exercise. Although psychosocial stress may also influence blood glucose, researchers have infrequently accounted for the three primary physiological factors when estimating the effects of stress. In addition, few investigators have considered the influence of everyday minor stressors on health outcome. The Tennessee Camp for Diabetic Children provided an opportunity to monitor insulin administration, dietary intake, and exercise levels and to obtain measures of blood glucose and perceived minor stressors. The best index of stress was one in which number and magnitude of negative stressors were combined into a cumulative stress measure. Negative cumulative stress significantly correlated with blood glucose levels after controlling for the effects of insulin, diet, and exercise. In addition, diabetes control tended to be better when adolescents, particularly boys, adjusted well to negative stress. These findings suggest that minor stressors can influence health outcome, but positive and negative stress need to be assessed independently.