Background: 90% of people with diabetes have stress, insomnia, decreased energy, temperature, appetite, weight, libido changes, and sympathetic/parasympathetic disturbance. These hypothalamic stress response disturbances result in impaired glucose control.Treating stress, sleep in short term studies(1-6 weeks) improves lifestyle, nutrition, exercise, and glucose control. Few studies have tested the hypothesis that improving stress will improve glucose control in long-term treatment.

Methods: We compared 80 stress-Rx adherent patients who achieved better sleep quality with 80 who did not. We recommend stress-Rx techniques four times daily like Benson’s relaxation exercises, deep breathing, meditation, and prayers. We quantified feeling of well-being, sleep duration extension, measured glucose control with AM insulin/glucose ratio, HgA1c, and in-target glucose when CGMS was available (16 patients). All patients followed our standard diabetes treatment protocol for type 2 including MIND nutrition plan and aerobic exercise 10 minutes after each meal (HIIT).

Results: At 12 months, adherents to Stress-Rx who achieved improved sleep improved the feeling of well-being by 78%, sleep increased 28 minutes, sleep onset latency decreased by 8 minutes. Insulin/glucose ratio was 16/133=0.12, HgA1c 7.1%, HgA1c<7 in 69%, and in-target glucose in 76% on CGMS (9 patients). On the other hand, in 80 patients who did not follow Stress-Rx and did not achieve improved sleep quality, feeling of well-being in 40%, sleep increased by 4 minutes,sleep onset latency decreased by 2 minutes. Insulin/Glucose ratio was 27/160=0.17, HgA1c 7.7%, HgA1c< 7 in 46%, and in-target-glucose in 58% on CGMS (7 patients.) Medications were 3 in both groups. Percentage needing basal insulin at the end was 8% in the good stress-Rx group, 16% in the non-improved sleep group.

Conclusion: Stress-Rx Improved insulin resistance with improved glucose control. Improved sleep, exercise, nutrition, and sympathetic outflow probably contributed 30%.


S. Sakkal: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at