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The Relation Between Stress and Insulin-Dependent Diabetes Mellitus: Physiologic Arousal or Disruption of Compliance?

The relations between minor life events, compliance, urine free cortisol, and blood glucose in 40 adults with insulin-dependent diabetes mellitus (IDDM) was examined. Specifically, this study explored whether naturallyoccurring minor stressful events had disruptive effects on metabolic control through: a) an arousal mechanism mediated by cortisol, b) disruption of the individual's adherence to prescribed treatment, c) a combination of arousal and disruption of compliance, or d) a third, unspecified mechanism. Stress did not influence metabolic control, either independently or via a stress-compliance or stress-arousal mechanism although stress was related to cortisol activity. Neither the direct effects of cortisol nor a cortisol by stress interaction successfully predicted metabolic control. Moreover, stress was unrelated to diet or exercise compliance and no relation between diet or exercise compliance and metabolic control was found. Only insulin compliance was found to influence metabolic control, although the effects of insulin compliance were independent of a stress-compliance relation. Implications of the results and directions for further research are discussed.