Assessment of the psychological factors and responses in self-managed patients

In past studies on the psychological aspects of diabetes mellitus, symptoms of depression have been identified as the most common manifestation among diabetic patients. Other psychological manifestations have been anxiety, hypochondriasis, increased dependence and passivity, and poor self-image. Ten insulin-dependent diabetic patients participated in a rigorous program of self-monitored blood glucose determinations, and their emotional response to the program was studied. They were initially bewildered and tended to resist passively to the demands of the program. With continuous experimentation and assertive trials, these patients developed better self-reliance, diminished anxiety, and better acceptance of their illness. Psychiatric assessments performed at the beginning of the study and after 8 mo revealed that all patients were depressed at the beginning of the study as reflected by high scores in the Hamilton Rating Scale. After 8 mo, all 10 patients had achieved better carbohydrate control, as reflected by decreased hemoglobin A1c levels, and were found to be much less depressed.