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Integrative type 1 diabetology

U-Health: Regulating emotions and stress in type 1 diabetes - a pilot study

Project overview

Type 1 diabetes (T1D) appears to be on the rise in Europe, and with it the burden of a range of outcomes, including health status, productivity, activity and utilisation of health resources (You & Henneberg 2016). The complexity of diabetes itself, blood glucose fluctuations and fear of long-term complications contribute to high diabetes-specific burden (Bollepalli et al. 2012). Around 373,000 adults and 32,000 children with T1D (Fisher et al. 2016) live in Germany, and the rate of new cases of T1D is currently increasing by 3.5% annually (http://T1dtoolkit.org).

According to international reviews, it is evident that despite modern technologies such as insulin pumps and continuous glucose monitoring systems, glycaemic control remains suboptimal for most people with type 1 diabetes (Prigge et al. 2022). The disease management programmes implemented in Germany have made it possible for around 50% of those affected to achieve the agreed HBA1c value. However, people with T1D are still at an increased risk of developing long-term psychological and neurological consequences such as depression and cognitive decline or macrovascular and microvascular comorbidities (Buchberger et al. 2016). 25.5 % of all T1D patients in Germany already suffer from double diabetes (Merger et al. 2016).

The question arises as to what resources people with such a complex disease as T1D can develop and what support they can utilise. Which integrative medical approaches can be helpful for them?

Further information

  • Responsible: Gerhard Kienle Chair of Medical Theory, Integrative and Anthroposophic Medicine
  • Funding: The study is funded by the Chaja Foundation.

Hypotheses

Those affected have repeatedly expanded the previous treatment concepts from their perspective (insulin dose adjustment, sport, fasting, closed loop). They have now discovered that limited emotional regulation skills can hinder appropriate diabetes management. This can involve a wide range of individual aspects - from a lack of ability to regulate stress to auto-aggressive behavioural patterns, depression or traumatic stress. It may be helpful to understand your own processes and learn appropriate regulation skills. Well-evaluated programmes to promote emotional competence, such as the Zurich Resource Model and training in the field of Somatic Experiencing and others, help with this. We now want to investigate this to see if they can be integrated into the care of people with T1D in the long term.

Intervention

The newly developed annual course is intended as a joint exploration of ways to not only regulate blood sugar, but also to develop self-help techniques for regulating emotional and stress levels. We will use modern findings and tools from psycho-neuro-immunology, current stress research, the Zurich Resource Model, Somatic Experiencing according to Peter Levine and introspection research. All steps are accompanied and deepened by mindfulness exercises and pressure-free perception and movement games in the context of music and movement.

Question

Is the programme of interest to those affected? Are enough of those affected taking part in the programme? How do they perceive the modules? Can emotional regulation be learnt by people with T1D and integrated into everyday life? Could this competence help to increase well-being and reduce the risk factors for an additional T2D as well as for depression and other secondary diseases?

Ethics: A positive vote was given by the ethics committee of Witten/Herdecke University.

Fasting for type 1 diabetes

Fasting, defined as the voluntary abstinence from solid food over a certain period of time, has been practised in numerous religions for thousands of years and is known in modern naturopathy as an important intervention that can have a beneficial effect on various ailments.

Buchinger fasting is a guideline-based multimodal intervention and includes exercise, resource-orientated training and mindfulness in addition to a diet based solely on liquids (broth, water, tea).

Fasting interventions were previously prohibited for people with type 1 diabetes. We have investigated the feasibility, the positive effects as well as fasting-related side effects: Fasting for people with T1DM is possible - taking into account the given risk factors.

We were also able to realise various sub-studies. We were able to examine the effects of fasting on the acid-base balance of the study participants. We also investigated the effects of fasting on cognition in a pilot study.

The award of the Hufeland Society 's Holzschuh Prize in 2021 emphasises the importance of this work and the need to continue it.

Further studies are in preparation, please feel free to contact us!

The cinnamon apple - first food after 7 days without solid food (Photo: Marion Christ)

A cinnamon apple sprinkled with cinnamon on a plate.

The solemn ceremony of breaking the fast after 7 days (Photo: Marion Christ)

In the centre of a circle of tea lights and paper stands are flowers and two baskets of fruit.

The tiresome finger prick - bloody glucose and ketone measurements were necessary for the study (Photo: Marion Christ)

A woman takes a blood glucose measurement on her finger.

For measuring the acid-base balance: collection and filling of the 24-hour urine (Photo: Marion Christ)

Measuring cup with urine

Publications on fasting for T1 DM

Co-operation partners of the fasting study

Links

Children and adolescents with type 1 diabetes

Around 32,000 children in Germany live with a diagnosis of type 1 diabetes. The trend is rising - especially during the coronavirus pandemic, the proportion of children with newly diagnosed T1DM, diabetic ketoacidosis at initial diagnosis and poor blood glucose control after diagnosis has increased. Children need to learn to consider the impact on blood glucose in everything they do, whether they are running around, playing or eating. Thanks to app and sensor-based continuous glucose monitoring, it is now possible for parents to take on this job. Nevertheless, the aim is for children to develop a comprehensive quality of life in addition to blood glucose regulation. To be able to test this, we have developed and validated our own self-efficacy scale for children and adolescents. We were able to map a holistic training programme for children and adolescents with type 1 diabetes, which includes the promotion of emotional and social skills.

Children and adolescents with type 1 diabetes have to give themselves insulin for the rest of their lives - with a syringe or an insulin pump (Photo: Dörte Hilgard)

A boy injects himself in the stomach.

Publications on T1 DM in children and adolescents

Introspection and First Person Perspective

Despite the continuous improvement of technical possibilities in diabetes management, the risks of secondary diseases and the costs of diabetes in old age are high. We design research from the perspective of those affected in collaboration with numerous established research groups and other people affected by type 1 diabetes. We share and discuss our research findings at the Institute for First-Person Research at Witten/Herdecke University. We are working on the links between stress and diabetes self-management and are developing a programme on emotional regulation competence (U-Health-Long version). We are exploring the significance of subjective theories of illness. We are investigating what support traditional or integrative treatment concepts can offer.

Contributions at conferences

Publications on First Person Perspective

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