To determine that stress factors have to impact on blood glucose control of the patients with type 2 diabetes mellitus who have used insulin

Thesis Type: Postgraduate

Institution Of The Thesis: Bursa Uludağ University, SAĞLIK BİLİMLERİ ENSTİTÜSÜ, Turkey

Approval Date: 2005

Thesis Language: Turkish

Student: Birgül Aydın

Supervisor: SELÇUK KIRLI


The aim of this study is to determine if stress factors have influence on blood glucose regulation of the patients with type 2 diabetes mellitus who use insulin. The sample is composed of patients with type 2 diabetes Mellitus who are over twenty years old, graduated at least from elementary school, have no evident cognitive distortion and use insulin treatment. Study group consists patients who don’t have blood glucose control. Control group consists patients who have blood glucose control. HbA1c level was used as indicator of blood glucose control. Patients in study group have HbA1c levels over %8, patients in control group have HbA1c levels equal to or less than %8. The sample is composed of seventy-eight patients who were inpatients or outpatients of Endocrinology Department in Bursa Uludag University (medical faculty) Hospital. Study group is composed of fourty-four patients. Control group is composed of thirty-four patients. Standardized Mini Mental State Examination, The Perceived Stress Scale, Somatization Scale, Hospital Anxiety and Depression Scale, Life Events List (B form), Multidimensional Scale of Perceived Social Support, Stress Coping Styles Scale, Type A Personality Scale, İrrational Belief Scale (Daily Behaviors Scale), Meaning of İllness Scale, Psychosocial Adjustment of İllness Scale – Self Report – PAIS-SR, Defense Mechanisms Inventory and a semi-structured interview form designed for this study were applied to all participants after receiving written consents. The institutional ethics committee had approved the study. Data have been evaluated by using SPSS version 13.0. Results of the study are as follows: 1. Two groups are statistically different from each other in acceptance of illness: - Patients who do not accept illness and who accept illness partially were more in number in the group including patients who do not have blood glucose control (p<0.05). Moreover necessity of illness acceptance is noted more in ratio in the group including patients who have blood glucose control (p<0.05). - The patients without blood glucose control perceived influences of the illness more and evuluate the illness as more stress causing (p<0.001). They report that illness influence their daily lives (p<0.05), relationships with their friends (p<0.05). and home/school/office jobs (p<0.01) more. * İnsulin treatment which is applied four times a day was seen more frequent in this group (p<0.01). *Response to illness and forecast about illness are at a more negative level in this group (p<0.05). 2. Findings from comparison of all group values with cut-off values determined in standartization study of scales and population values: Although there is not a difference between two groups, results of study group were compared with means of population or cut-off points of perceived stress scale, psychosocial adjustment of illness scale and defensive mechanism scale. *According to hospital anxiety and depression scale, 46.1%of diabetic patients in study got point over cut-off point for depression. 21.7% of them got point over cut-off point determined for anxiety. *According to perceived stress scale, only 12.8% of all patients have low stress level. 48.9% have moderate stress level, 38.4% have high stress level. *According to psychosocial adjustment of illness scale, 37.1% of patients have good psychosocial adjustment, 37.1% of patients have moderate psychosocial adjustment and 25.8% of patients have bad psychosocial adjustment. * According to defense mechanism scale, when normal group values were compared with women and men with type 2 diabetes mellitus, it was determined that all patient group were using defense mechanisms more than normal group at different levels between p<0.05 and p<0.0001. Finally, these findings support the stress theory of Lazrus and Folkman. Lazarus and Folkman believed that the interpretation of the stressful events was more important than the events themselves. They define stress as a particular relationship between the person and enviroment that is appraised by the by the person as taxing or exceeding his or her resources and endangering his or her well-being. Emotions are organized psychophysiological reactions consisting of cognitive apprasials, action impulses and patterned somatic reactions. As a result, the group of patients without blood glucose control have problems with acceptance of illness, perceive influences of illness more severe and stress causing, have more negative estimation of illness and response to illness, have more negative evaluation and compherension of illness. Patient without blood glucose control interpret the illness as a stress causing factor. Negative evaluation of illness leads to negative feelings and psychopysiological reactions. This causes high levels of blood glucose at type 2 diabetes Mellitus patients by the psychopysiological reactions “fight-flight” and behaviours essential for compliance are affected negatively. The study emphasizes impotance of improving programs especially focused on the meaning of illness for the patient at stress coping programs for blood glucose control of diabetic patients.