ROLE OF STRESS IN THE ETIOLOGY AND TREATMENT OF DIABETES-MELLITUS

Stress has long been suspected as having major effects on metabolic ac tivity. The effects of stress on glucose metabolism are mediated by a variety of ''counter-regulatory'' hormones that are released in respon se to stress and that result in elevated blood glucose levels and decr eased insulin action. This energy mobilizing effect is of adaptive imp ortance in a healthy organism, However, in diabetes, because of a rela tive or absolute lack of insulin, stress-induced increases in blood gl ucose cannot be adequately metabolized. Thus, stress is a potential co ntributor to chronic hyperglycemia in diabetes, although its exact rol e is unclear. Although there is some suggestion from retrospective hum an studies that stress can precipitate type I diabetes, animal studies are contradictory with different stressors either having facilatory o r inhibitory effects upon the development of the disease. Human invest igations in patients with established diabetes are equally confusing w ith some showing that stress can stimulate hyperglycemia, hypoglycemia or have no effect at all on glycemic status. There is more consistent evidence supporting the role of stress in animal models of type II di abetes. However, human studies on the role of stress on the course of established type II diabetes are few. Intervention studies suggest tha t behavioral or pharmacologic intervention to manage stress may contri bute significantly to diabetes treatment, but more long-term research is needed. It is concluded that further research is needed to establis h the importance of behavioral factors in the etiology and management of diabetes, and several areas of methodologic improvement are suggest ed.