Building Competency in Diabetes Education THE ESSENTIALS

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diabetes peer led support groups have provided an invaluable source of encouragement for the person with diabetes.

Stress and diabetes The fast pace of life in the 21 st century has ensured us that stress will be a factor to contend with throughout our lives. For the general population, stress affects our cognitive, social and affective processes (137) influencing how we feel, act and react to life situations. When patients are diagnosed with diabetes, these stress factors are heightened and additional stressors are recognized as patients learn to cope with the burden of chronic illness. In the DAWN2 study, patients reported that diabetes related distress had a negative impact on many aspects of their lives, including QOL, family/friend relationships and physical health (5). Other researchers have highlighted the relationship between the physical response to stress and the biological stress response leading to negative health outcomes (135,137,138). The impact of stress on our QOL is considered to be the most significant intervention point (135). Understanding the disease specific stressors and their impact on diabetes self-management is of critical importance in order to implement problems-solving and coping skills interventions (113,139). People with diabetes will have individualized responses to stress. It is necessary to explore each patient’s personal definitions and to identify situations or circumstances he/she associates with both mild and excessive stress. The stress response induced by the diagnosis of diabetes and its burden of management involves many levels of highly complex functioning processes referred to as the stress network (140). This network is activated by stressors, which are factors described as agents, conditions or stimuli that are considered threatening as experienced by the individual. Stressors include, but are not limited to, biological factors, including the immune system, behavioural factors mediated by cognition and affective responses, and societal factors creating barriers to effective self-management (141). Specific sources of stress for the person with diabetes include the following: • Feeling different/being different. • Loss of control. • Financial costs of care. • Conforming to requirements for self-management. • Time devoted to diabetes care.