RESEARCH FINDINGS USING GUIDED
IMAGERY FOR
DIABETES
July, 2006
Definition
of the Problem
Diabetes mellitus (DM) refers
to two related illnesses. Both affect how a person
metabolizes glucose (sometimes called “blood sugar”). In
Type I diabetes, the pancreas stops producing insulin,
possibly because of an autoimmune process of some kind.
Type I diabetics need carefully monitored insulin
replacement therapy to survive. Type I diabetics make up
around 10% of the diabetic population (Votey and Peters,
2005a).
In Type II diabetes, the pancreas may or may not be
producing enough insulin, but the insulin receptor cells
have closed down (“insulin resistance”). The liver may also
be affected, producing more glucose than the body needs
(Votey and Peters, 2005a).
Type II diabetes is associated with high-fat, high-calorie
diets, sedentary lifestyles, overweight, and economic
hardship (Black, 2002; Bo, Menato et al, 2002; Votey and
Peters, 2005b).
Stress is a major contributing factor in diabetes. It
raises blood glucose by stimulating the release of glucose
by the liver, and can also interfere with people following
their doctors’ orders and recommendations (Surwit, van
Tilburg et al, 2002; Arsham and Lowe, 1997).
Scope
and Cost of the Problem
Diabetes is one of the most
prevalent, most expensive, and fastest growing chronic
conditions in the U.S.A. and the world. About 18.2 million
Americans had diagnosed diabetes in 2002 (Votey and Peters,
2005a). In 1998, their care involved 513,000 hospital
admissions, averaging 5.2 days per stay (Hall and Popovic,
2000).
Direct medical expenditures for diabetes in 1997 totaled
$44.1 billion – about $7.7 billion for glycemic care, and
$36.4 billion for treatment of complications and excess
prevalence of general medical conditions (Votey and Peters,
2005b). People visited doctor’s offices
24.7 million times in 1999-2000 for Type 2 diabetes alone
(Burt and Schappert, 2004).
According to the American Diabetes Association, indirect
costs of diabetes (from premature mortality and disability)
in 1997 totaled $54.1 billion. Total medical expenditures
incurred by people with diabetes totaled $77.7 billion or
$13,243 per person, compared with $2,560 for people without
diabetes (Votey and Peters, 2005). ADA research also found
that in the United States, diabetes accounted for a loss of
nearly 88 million disability days in 2002).
Diabetes is a chronic illness in which outcomes, quality of
life, and use of medical resources depend almost entirely
on patient compliance. That is, the ability to follow
prescribed diet, exercise, glucose monitoring, infection
prevention, and medication regimens.
But many find this program burdensome and frustrating
(Polonsky, 1999). Noncompliance is the biggest cause of
diabetic complications, including kidney failure,
blindness, amputation, and heart disease (Arsham and Lowe,
1997). Any
program that enables patients to better comply with
treatment plans will be extremely valuable and
cost-effective.
Medical
Treatment
Medical treatment of Type I
diabetes centers on insulin replacement, which is usually
done by self-administered injections. Continuous insulin
pumps are now available for some patients and allow for
greater glycemic control and ease of treatment. Type II
diabetics are usually treated with oral medications
(sulfonylureas, biguanides, alpha-glucosidase inhibitors,
and thiazolidinediones) (Arsham and Lowe, 1997).
Compliance
with Diabetes Treatment
The Diabetes Clinical Control
Trial (NIDDKD, 2003) demonstrated that diabetics who
maintain excellent glycemic control face relatively little
risk of kidney failure, retinopathy, or amputation.
Improvements in glucose testing technology and medications
have made glucose control possible for a greater number of
diabetics. Still, the physical and psychological demands of
tight control are difficult for many patients.
The Role of Relaxation, Hypnosis, and Imagery
Stress reduction is a vital
part of diabetes management. This is especially true in
Type II diabetes, where it appears to lower blood glucose
directly (Feinglos, Hastedt and Surwit, 1987; Surwit, van
Tillberg et al, 2002).In Type I, the advantages of
relaxation, hypnosis, biofeedback, and guided imagery
appear to stem largely from improved behaviors, although
there is some evidence of a direct effect (McGrady and
Gerstenmaier, 1990; Ratner, Gross et al, 1990).
Researchers found that both depression and anxiety worsen
glycemic control both directly, and indirectly through
behavior (McGrady and Horner, 1999). Depression and anxiety
can be partially relieved through relaxation and
self-hypnosis (guided imagery) (Davidson, Fambach and
Richardson, 1978; Stetter, Walter et al, 1994).
Other researchers
found that several areas of diabetes self-care behavior
improved in a group of patients who listened to guided
imagery tapes (Wichowski, Jubsch, 1999).
Biofeedback and relaxation significantly lowered blood
glucose, A1C, muscle tension, depression, and anxiety in
subjects (McGinnis, McGrady et al, 2005). Thermal
biofeedback, when used alone or in combination with other
mind-body techniques, can improve quality of life and the
level of activity by improving blood flow, pain,
neuropathy, healing ulcers (Galper, Taylor, et al, 2003).
Conclusion
A low-cost guided imagery-based
program can improve compliance in diabetics of both types
and improve glycemic control in Type II diabetics.
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