Psychological effects of intensification of diabetic control

Abstract

We studied the psychological effects of a program of intensification of glycemic control, using three different insulin regimens: (1) twice-daily regular and lente insulin; (2) multiple preprandial doses of regular insulin coupled with long-acting ultralente insulin; and (3) continuous subcutaneous insulin infusion (CSII). Ten patients used each of the regimens for periods of 2 mo. Patients monitored blood glucose 4-7 times daily. Using the Hopkins Symptom Checklist, there were significant reductions in depression, interpersonal sensitivity, and anxiety during all three treatment programs. Self-concept scores were more positive following CSII therapy. Positive self-concept ratings were correlated with positive attitudes about diabetes, medical care, persons with diabetes, and current diabetes regimens. After all subjects had experienced CSII, self-concept was positively related to attitudes regarding the insulin pump. Patients reporting more positive attitudes toward their current diabetes regimens had lower glycosylated hemoglobin levels. Thus, there were no adverse psychological effects of blood glucose monitoring, intensification of therapy, or use of infusion pumps by the parameters measured.