Psychologic stress and glycemic control: a comparison of patients with and without proliferative diabetic retinopathy.

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Abstract
Using a case/control design, patients with (cases) and without (controls) proliferative diabetic retinopathy were compared using 3 psychosocial measures: life events, psychiatric symptomatology and ego development. Cases reported significantly more symptoms. They also demonstrated a modest and significant correlation of negative life events with HgbA1c [Hb subtype A1c] that was not shown in the controls. When the relationship of life events with glycemic control was explored in cases of varying durations of proliferative retinopathy, the association between negative life events and HgbA1c was accounted for by the cases with a recent onset of retinopathy. Patients in this recent group showed a trend towards more negative life events that decreased with longer duration of proliferative retinopathy. The onset of proliferative retinopathy apparently portends a life crisis during which metabolic control is sensitive to additional life stress and this association is not found among patients whose illness is more stable.