The experiments proposed herein are designed to explore the efficacy and mechanism of progressive relaxation training and benzodiazepine therapy in improving glucose metabolism in non- insulin dependent diabetes mellitus (NIDDM). Fifty NIDDM patients will participate in two experiments sequentially. In the first experiment patients will receive a glucose tolerance test, an insulin tolerance test, an epinephrine sensitivity test and psychometric assessment. Serial blood samples will also be drawn for glucose determination. Subjects will then be randomly assigned to receive alprazolam (a benzodiazepine) or matched placebo. After 8 weeks, the glucose will be drawn for glycohemoglobin measurement. The drug condition of patients will then be reversed and subject will be reevaluated 8 weeks later. Four weeks following the termination of the drug study, patients will be readmitted to the hospital during which time the glucose tolerance test will be performed on all patients. Serial blood samples for glucose determination will also be drawn. All patients will then be randomly assigned to either control or treatment conditions: 1) progressive relaxation with compliance enhancement instructions and 2) no behavioral treatment. Patients will return periodically for assessment of glycohemoglobin, fasting and 2-hr postprandial blood glucose. Glucose tolerance tests will be repeated at 24 weeks and 48 weeks. The effects of the pharmacologic and behavioral interventions will be assessed by their affects on glycohemoglobin. The mechanism of action of these interventions will be assessed during hospital admissions and outpatient visits. An attempt will be made to predict responses to both benzodiazepine and relaxation therapies by subjects' responses to the epinephrine sensitivity test and """"""""paper and pencil"""""""" psychometric assessment.
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