This project will determine if a relaxation-based stress management training program can have a significant impact on blood glucose control in high Trait Anxious patients with non-insulin dependent diabetes (NIDDM). Men and women with NIDDM will be screened with the Spielberger State Trait Anxiety Inventory (STAI) and, using standardized norms, classified as low or high anxiety individuals. After baseline assessment, 120 patients with high anxiety and 120 patients with low anxiety will be stratified by weight and randomized to either intervention or control condition. Experimental subjects will attend five weekly, small group sessions of relaxation-based stress management training and general diabetes education. Control subjects will attend five identically scheduled sessions of general diabetes education. Subjects will be followed for 1 year and blood glucose control will be assessed at baseline, 2 months, 4 months, 6 months and 12 months with measures of: glucose tolerance, glucose stimulated insulin response, mean and variability of self-monitored blood glucose over one week, glycated hemoglobin and serum fructosamine. Assessment of anxiety, as well as frequency of use of stress management techniques will be made utilizing the STAI, the General Health Questionnaire (GHQ) and the perceived Stress Scale, at baseline, 2, 4, 6 and 12 months. In an exploratory analysis involving low Trait anxious subjects we will investigate whether patients exhibiting the repressive coping style (characterized by low Trait Anxiety and high Social Desirability) also demonstrate improvements in glucose control with stress management training.
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