Emotional adjustment to diagnosis and intensified treatment of gestational diabetes.

OBJECTIVE

To determine, in women having newly diagnosed gestational diabetes mellitus, the effect of intensified treatment on the patients' emotional status and the relation between metabolic control and emotional well-being.

METHODS

English-speaking women with newly diagnosed gestational diabetes mellitus (N = 206) and nondiabetic controls (N = 95) were compared for maternal characteristics and test results on the Profile of Mood States-Bipolar test, a standardized Likert scale measuring mood dimensions in terms of six bipolar affective states. Women with gestational diabetes mellitus were stratified according to treatment modality (diet or insulin therapy) and level of glycemic control (good control, mean blood glucose less than 105 mg/dL; poor control, mean blood glucose 105 mg/dL or greater). Because emotional profile can be influenced by actual glucose values depicted on the memory reflectance meter, glucose determinations were categorized as hypoglycemia, normoglycemia, mild hyperglycemia, and hyperglycemia. An Average Mood Disturbance score was used to determine the relation between total mood status and categories of glucose determinations.

RESULTS

There was no significant difference between women with gestational diabetes mellitus in either the diet- or insulin-managed group and nondiabetic controls on each of the subscales of the Profile of Mood States-Bipolar test. Patients with stringent glycemic control were less distressed than those having poor control. Intensified therapy (self-monitoring of blood glucose levels and liberal use of insulin) for gestational diabetes mellitus does not negatively affect patients' emotional status. Insulin therapy by multiple injection does not adversely affect mood state. Stepwise regression analysis found a significant association between Average Mood Disturbance score and the number of determinations within the normoglycemic and hyperglycemic categories, marital status, and maternal age.

CONCLUSION

Intensified management of newly diagnosed gestational diabetes mellitus does not increase patient anxiety and depression. Moreover, achievement of glycemic control contributes to patient reassurance. Psychological adjustment to the temporary disease state is then equal to that of a nondiabetic individual.