Stress In Diabetic Patients Research Articles

Platelet and clotting activities after cold stress in diabetic patients

Platelet and clotting abnormalities have been described in diabetes, but little is known about their relationship to daily stresses. In order to evaluate whether states of abnormal carbohydrate metabolism modify the hemostatic response to stress, 12 subjects with type I diabetes mellitus, 9 with type II, with impaired glucose tolerance and 10 healthy controls were exposed to a cold pressor test. Plasma concentrations of beta-thromboglobulin (index of platelet activation) and of fibrinopeptide A (index of thrombin formation) were measured before and 15 minutes after forearm immersion in melting ice. Basal levels of both proteins were significantly elevated (p<0.02) in the combined group of patients with diabetes and impaired glucose tolerance. While in healthy controls cold exposure failed to modify plasma concentration of either protein, obvious changes occurred in the diabetic and impaired glucose tolerance groups. In the combined patients group, beta-thromboglobulin levels decreased from 1.37±0.44 nmol/1 to 1.03±0.39 (mean±SD,p<0.01), after the cold test, possibly in consequence of enhanced vascular permeabilityl while fibrinopeptide A levels increased from 1.52±1.03 nmol/l to 3.45±4.19 (p<0.02).The degree and pattern of abnormalities observed in basal as well as stimulated levels of fibrinopeptide A differed somewhat among the three groups of patients. These studies indicate that, in the basal state patients with diabetes or simple carbohydrate intolerance are more susceptible than controls to platelet activation and that after stress thrombin formation can occur although some variability exists among and within groups of patients. The consequences of such increased thrombotic activity may have a bearing on the pathogenesis of large vessel disease, a complication common to diabetes and impaired glucose tolerance.

The role of aerobic exercise in reducing stress in diabetic patients.

In addition to providing direct physical benefits to diabetic patients, aerobic exercise may also provide psychological benefits, including the reduction of stress. Stress reduction in diabetic patients may directly improve their quality of life as well as indirectly alter the course of their disease. This paper reviews a representative sample of studies that examined the effects of aerobic exercise on physiological and subjective responses to stress, and presents relevant clinical issues, including the minimization of potential risks, an exercise prescription, and suggestionsfor enhancing exercise adherence.