Early Intensive Diabetes Treatment Can Negatively Affect Stress and Outcome

Although patients with type 2 diabetes usually experience little anxiety in the first years of their diagnosis, early and intensive treatment can affect patients’ psychological outcomes, resulting in higher anxiety and less self-efficacy. "There is an ongoing debate on screening for type 2 diabetes," Dr. Bart J. Thoolen, of Utrecht University, the Netherlands, and colleagues write. "Advocates emphasize the advantages of detecting diabetes in patients at an early stage of the disease, as an early and intensive treatment may reduce diabetes-related morbidity and mortality."

The researchers included 196 patients diagnosed 3 to 33 months previously who were receiving usual care or intensive multifactorial pharmacological treatment. Main outcome measures included anxiety, depression, diabetes-related distress, perceived seriousness and vulnerability, self-efficacy, and self-care. The team used multivariate analysis to evaluate variations in outcomes based on time since diagnosis (less than 1 year versus 2 to 3 years) and intensity of treatment.

The majority of patients reported little distress and low perceived seriousness and vulnerability. Most patients also reported high self-efficacy and low self-care. These outcomes varied greatly across conditions. There was a significant effect of time for perceived vulnerability (p < 0.001). Compared to patients with a more recent diagnosis, those diagnosed between 2 and 3 years previously considered their diabetes more threatening.

Patients who received intensive treatment reported more distress and less self-efficacy in the first year. Patients who received usual care showed more distress and less self-efficacy 2 to 3 years after diagnosis.

"This study emphasizes the importance of taking variations between patients into account in the development and implementation of (self-care) programs for patients with a recent diagnosis of type 2 diabetes during a screening trial," Dr. Thoolen and colleagues conclude. "It also suggests that clinicians should be more attuned to patients’ psychological needs when they first prescribe (more) intensive treatments, when acknowledging the distress that strict regimens may produce, when assessing their illness cognitions, and when actively addressing problems with regard to their self-care."
Diabetes Care 2006;29:2257-2262.

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