This study was undertaken in order to re-evaluate the possible causes responsible for secondary failure in diabetic treatment with oral hypoglycemic drugs from the viewpoint of psychosomatic medicine. Of all the 127 diabetic outpatients who had been treated with oral drugs, 85 cases were available for the following psychosomatic analysis. Among them, 20 cases (23.5% of the total) were designated as secendary failure. Various kinds of routine clinical examinations, including IRI response during a glucose tolerance test, were done just at the time of the secondary failure. Their psychological problems were also checked by carrying out personality tests, interviews, glucose tolerance tests by mental stress loading and, with as many patients as was possible, their diets were monitored for one week.Only three cases were likely to have "true" secondary failure, where drug intolerance or exhausted endocrine function of beta-cells of the pancrease was highly suspected, because of extraordinarily low response of IRI levels during glucose tolerance tests. Sixteen cases (80% of the total) had accompanying psycho-social stress with a higher anxienty level induced by chronically continued emotional conflicts.There were complications in some cases : for example, some patients were suffering from such mental diseases as psychopathy, neuroses and depression. The results from monitoring the diets, indicated that they acted on impulse, taking high caloric foods, usually at the dinner hour, some of them showing a trend to be addicted to either sweets or alcoholi liquors, which sugested a means to reduce those feelings of anxiety and/or frustration, resulting in obesity. Other possible factors responsible for secondary failure were : unwise initial selection of drugs, 2 cases;interruption of drugs by the patients themselves, 8 cases;temporary metabolic stress due to infections or acute administration of steroid at operation, 3 cases.In most of these cases with secondary failure, better diabetic controls were obtained again by introducing psychosomatic treatments, especially by controlling the abnormal eating patterns.These results suggest that secondary failure with oral hypoglycemic drugs in diabetic patients is intimately related to psychological factors. Consequently, adequate psychosomatic counselling is necessary for preventing such patients from experiencing secondary failure.
