Wall Street, Stress and Diabetes.

Good grief. Major financial houses are vaporizing. Stock prices are tanking. Dire headlines are extending across not three but all six columns of the Wall Street Journal. And if Mad Money Cramer's reaction is emblematic of the resulting emotional turmoil among the financial traders, it’s likely that there’s some major stress out there. Since there is no reason to believe that workers in the major exchanges are any more immune to chronic illnesses like diabetes, the Disease Management Care Blog wonders if level of stress can really lead to poor chronic disease control. In these times of high anxiety, are there more polydipsic and polyuric traders out there? If so, what is the role of population-base approaches to care?

The answer to that question is more complicated than readers may imagine. It is well known that depression and anxiety are more prevalent among persons with diabetes mellitus. Whether having diabetes causes stress, or if the stress causes the diabetes, or if other factors cause both is unknown. Either way, persons prone to anxiety will experience more of it when they are stressed. But what is the impact on blood glucose control among persons with diabetes?

One way to answer the question is a clinical trial in which patients are intentionally exposed to stress. This was a study involving persons with Type 1 diabetes mellitus. Interestingly, if they were fasting at the time of the exposure, their blood glucoses did not increase. However, stress applied following a meal showed a delayed but significant increase in the blood glucose.

Such a clinical trial has not been done among persons with the more common (including on Wall Street) Type 2 form of diabetes. However, check out this natural experiment from Japan. The DMCB leaves it to readers to decide if earthquakes compare to the temblors roiling the U.S. stock markets, but this study showed a life threatening 7.2 Richter stress caused a widespread bump in the A1c among persons with diabetes compared to persons experiencing a milder 4.2 earthquake in another part of the country. The authors suggest the cause was a combination of disruptions in the neuroendocrine system as well as an impaired psychological ability to adhere to diet, lifestyle and medications.

Given these data, it may be tempting to equip a battalion of disease management coaches with bromo-seltzers, Xanax and insulin and parachute them into Manhattan. A better approach may be to alert anxiety-ridden patient-enrollees and their disease management nurses to the important role of emotional stress in blood glucose control. Awareness may be half the battle. Formal stress management interventions may also help. So would opening the Fed Window, lowering interest rates and reducing the federal deficit. Cramer may prefer the latter interventions, but for his colleagues with diabetes, it may be more realistic and worthwhile to stick with the former.