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Effect of the Kobe Earthquake on Stress and Glycemic Control in Patients With Diabetes Mellitus
Akio Inui, MD, PhD;
Haruko Kitaoka, MD, PhD;
Motoko Majima, MD, PhD;
Shizuo Takamiya, MD, PhD;
Masaharu Uemoto, MD, PhD;
Chika Yonenaga, CP;
Masako Honda, CP;
Keiko Shirakawa, CP;
Naohiko Ueno, MD;
Kazuhiko Amano, MD, PhD;
Sumiharu Morita, MD, PhD;
Akira Kawara, MD, PhD;
Koichi Yokono, MD, PhD;
Masato Kasuga, MD, PhD;
Hiroshi Taniguchi, MD, PhD
Arch Intern Med. 1998;158:274-278.
Objective To examine the effects of the Kobe, Japan, earthquake, a life-threatening event, on stress and glycemic control in diabetic patients.
Patients and Methods Hemoglobin A1c levels before and after the earthquake were evaluated in diabetic patients in Kobe (N=157; magnitude, 7.2) and in Osaka, Japan, as a control (N=277; magnitude, 4.2), where little damage to houses and traffic facilities occurred. Glycosylated hemoglobin levels were also compared with those of 2 years before and 1 year after the earthquake. The General Health Questionnaire (GHQ) and a self-administered questionnaire regarding damage to houses and relatives killed or injured were used to assess psychological and mental stresses on earthquake survivors.
Results Glycemic control was aggravated in diabetic patients after the earthquake in Kobe but not in Osaka. The GHQ scores were significantly higher in the patients in Kobe than those in Osaka. Increased hemoglobin A1c concentrations and high scores on the GHQ were especially evident in diabetic patients with severe damage to houses and/or with relatives killed or injured.
Conclusion These results suggest an association between chronic, life-threatening stress and the worsening of metabolic control in patients with diabetes mellitus.
From the Second Department of Internal Medicine (Drs Inui, Ueno, Amano, Morita, Yokono, and Kasuga), the Departments of Metabolism and Community Health Science (Dr Taniguchi) and Psychiatry (Mss Yonenaga and Honda), Kobe University School of Medicine; the Department of Psychiatry (Drs Takamiya and Uemoto and Ms Shirakawa), Nishi-Kobe Medical Center; the Kawara Clinic (Dr Kawara), Kobe; and the First Department of Internal Medicine (Drs Kitaoka and Majima), Osaka Medical College, Takatsuki, Japan.
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