Diabetes distress,illness perceptions and glycaemic control in adults with type 2 diabetes

The emotional distress associated with adjusting to and living with diabetes has been termed diabetes distress. Diabetes distress is associated with glycaemic control but interventions to reduce diabetes distress have failed to consistently improve diabetes control. Various illness perceptions have previously been linked with both diabetes distress and glycaemic control but interrelationships between these features have not been previously investigated. We hypothesised that illness perceptions mediate the relationship between diabetes distress and glycaemia. Participants with type 2 diabetes attending diabetes outpatient clinics (n = 84) provided demographic and clinical information and completed the Diabetes Distress Scale-17 and the Brief Illness Perceptions Questionnaire. Using regression analysis we demonstrated that the illness perceptions of personal control, regimen-related distress, socioeconomic status and insulin use were significant contributors in the final model predicting HbA_1c. Higher levels of personal control were associated with better glycaemic control. Conversely, regimen-related distress was associated with hyperglycaemia. Mediation analyses showed that the relationship between regimen-related distress and HbA_1c was mediated by personal control. Our work suggests that psychological interventions designed to reduce diabetes distress may be more efficacious in improving glycaemic control if they address an individual’s perception of personal control.     

Illness representations predict adherence in adolescents and young adults with type 1 diabetes

Objective: Most adolescents and young adults (AYAs) with type 1 diabetes struggle with diabetes self-management and exhibit suboptimal glycemic control. This study examined two models of association between illness representations, a modifiable predictor of suboptimal outcomes, and adherence and glycemic control in AYAs with type 1 diabetes.

Design and main outcome measures: Ninety-nine AYAs (ages 15–20?years) completed measures of illness representations and adherence at two visits. Blood glucose monitoring frequency and haemoglobin A1c were obtained via chart review. Relationships were examined using structural equation modelling.

Results: Illness representations accounted for a significant proportion of the variance in blood glucose monitoring frequency (ΔR^2?=?.23, p?<?.01) and adherence to emergency precautions at Time 1 (ΔR^2?=?.07, p?=?.03). Illness representations also accounted for significant variance in blood glucose monitoring frequency (ΔR^2?=?.08, p?=?.01), adherence to recommendations for insulin and food (ΔR²?=?.08, p?=?.02) and exercise (ΔR^2?=?.10, p?<?.01), and adherence to emergency precautions (ΔR^2?=?.16, p?<?.01) at Time 2.

Conclusion: Illness representations are salient predictors of adherence in this population. Interventions targeting adherence promotion and glycemic control in AYAs with type 1 diabetes may be enhanced by efforts to modify illness representations.     

Comparison of the role of self-efficacy and illness representations in relation to dietary self-care and diabetes distress in adolescents with type 1 diabetes

This cross-sectional study examined the joint effects of self-efficacy and illness representations on dietary self-care and diabetes distress in adolescents with type 1 diabetes by comparing two theoretical models: the Self-regulation Model (Leventhal, H., Meyer, D., & Nerenz, D. (1980). The common-sense representations of illness danger. In S. Rachman (Ed.), Medical Psychology (Vol. 2, pp. 7–30). New York: Pergamon.) and Social Cognitive Theory (Bandura, A. (1997). Self efficacy: The exercise of control. New York: W.H. Freeman.). One hundred and fifty-one adolescents with type 1 diabetes completed self-report measures of dietary self-efficacy, illness representations, dietary self-care and diabetes distress. Data were analysed using structural equation modelling. The model best supported by the data (Leventhal's Self-regulation Model) showed that dietary self-efficacy, perceived consequences and treatment effectiveness had direct and independent effects on both dietary self-care and diabetes distress. Together with dietary self-efficacy, perceived short-term treatment effectiveness was a significant predictor of dietary self-care. Age was found to be a negative predictor of short-term treatment effectiveness beliefs. Diabetes distress was best predicted by self-efficacy and perceived consequences. It can be concluded that to target effectively dietary self-care and distress, clinicians should focus on key illness representation variables (perceived short-term treatment effectiveness and perceived consequences) in conjunction with self-efficacy.     

Relationship beliefs and illness appraisals are differentially associated with specific ways of coping in spouses of patients with type 2 diabetes

Using data from 117 spouses of patients diagnosed with type 2 diabetes and multiple-group path analysis, the current study explored the association of four relationship beliefs (satisfaction, sacrifice, confidence and instability) and four diabetes appraisals (consequences, distress, control and efficacy) with illness-specific coping behaviour: active engagement, protective buffering and overprotection. The potential moderating effect of gender was also tested. Results indicated gender did moderate the associations among the variables in the model, with the association of relationship satisfaction and active engagement being significantly stronger for men, while diabetes control was more strongly related to protective buffering for women. The only variables associated with active engagement were three relationship-specific cognitions: higher levels of relationship satisfaction (for men only), satisfaction with sacrifice and relationship confidence were all related to higher active engagement. The diabetes appraisals were the only variables associated with protective buffering and overprotection. Higher diabetes distress and diabetes control (for women only) and lower diabetes efficacy were predictive of greater protective buffering. Lower diabetes efficacy and higher diabetes control were associated with greater overprotection. Implications for theory, research and practice are discussed.     

Coping with type 1 diabetes through emerging adulthood: Longitudinal associations with perceived control and haemoglobin A1c

Objective: This study, which is part of a larger longitudinal study focusing on the biopsychosocial functioning of emerging adults with type 1 diabetes, examined how perceived personal control, coping and HbA_1c relate to one another over time.

Design and main outcome measures: Emerging adults with type 1 diabetes (18–30 years old) participated in a two-wave longitudinal study spanning five years (N = 164 at Time 1). At both times, patients completed questionnaires on perceived control and coping (i.e. diabetes integration, avoidant coping and passive resignation). HbA_1c values were obtained from treating clinicians. We investigated the directionality of effects using cross-lagged path analysis.

Results: Higher HbA_1c values predicted relative decreases in diabetes integration and increases in avoidant coping five years later. Feeling less in control over diabetes predicted the use of passive coping over time. Passive coping predicted a relative decrease in perceived control five years later.

Conclusion: These findings indicate that tackling poor glycaemic control is not only important to avoid medical complications but also to prevent patients from resorting to more avoidant coping strategies. Furthermore, given the longitudinal interplay between perceived control and passive coping, it is important that intervention efforts include both cognitive and behavioural components to be effective.     

Dissimilarity in mother and adolescent illness representations of type 1 diabetes and negative emotional adjustment

The study explored how two measures of mother–adolescent dissimilarity in illness representations relate to negative emotional adjustment in mothers and adolescents. Eighty-four adolescents with type 1 diabetes (age 11.5–17.5) and their mothers completed the Revised Illness Perceptions Questionnaire and measures of negative emotional adjustment. Adolescents viewed diabetes as less chronic, containing fewer negative emotional representations, and that mother had less control over the illness than did mothers. Mother–adolescent mean differences in representations were not associated with negative adjustment for adolescents; mean differences in coherence were related to negative adjustment for mothers, when controlling the individual's own representations. A measure of dissimilarity based on the sum of squared differences between mother and adolescent was associated with negative adolescent adjustment when controlling adolescent's own representations, but no relations were found for mothers. Dyadic approaches to coping with chronic illness will benefit by understanding how dissimilarity in illness representations between patient and caregiver relate to adjustment.     

Associations between type of treatment and illness-specific locus of control in type 1 diabetes patients

Abstract

This study examined differences in diabetes-specific locus of control beliefs of 82 insulin-treated Type I diabetes patients undergoing either conventional therapy (CT), intensified conventional therapy (ICT) or continuous subcutaneous insulin infusion (CSII). Compared to CT with its adherence to a strict regimen, ICT and CSII allow a much greater flexibility in timing of meals and daily activities. On the other hand, such flexibility requires a much more active role of the patient. The hypotheses of higher internality and lower powerful others locus of control beliefs in ICT and CSII patients than in CT patients could be supported for powerful others locus of control only. A one-year follow-up replicated this finding. Furthermore, high powerful others locus of control was associated with low diabetes-related knowledge and poor glycaemic control. The relevance of the patients' experience with the respective treatment is examined in view of the results and implications for studies on the feasibility of diabetes regimens are discussed.     

Perceptions of treatment control moderate the daily association between negative affect and diabetes problems among adolescents with type 1 diabetes

Perceived control over diabetes may serve to buffer the relationship between adolescents’ experience of daily negative affect and daily problems with diabetes. In a daily diary study including 209 adolescents (ages 10.5–15.5) with type 1 diabetes, we examined how daily affect related to daily fluctuations in experience of diabetes problems, and whether perceptions of control moderated these daily associations. Using hierarchical linear modelling, we found that day-to-day experiences of negative affect were associated with more frequent daily diabetes problems. Perceptions of treatment control moderated associations between negative affect and number of problems; negative affect was more strongly associated with number of problems among teens perceiving lower versus higher treatment control over their illness. The same pattern of association was not apparent for personal control. Results suggest that perceived treatment control may help to buffer detrimental associations between negative affect and adolescents’ ability to successfully manage their diabetes.     

Individual Growth Curve Modeling of Specific Risk Factors and Memory in Youth with Type 1 Diabetes: An Accelerated Longitudinal Design

Objective: To examine if diabetes risk factors disrupt memory score trajectories in youth with T1D over three years with a powerful accelerated longitudinal method and individual growth curve modeling. Methods: Participants aged 9–17 completed memory measures at study enrollment and two years later. Results: Poorer metabolic control over the course of the study related to a significant decrease in visual memory scores. Compared to baseline, these youth scored 1.99 points lower at follow-up. Generally appropriate developmental gains were made in memory trajectories and girls' visual and verbal memory improved more than boys. No significant effects of disease duration, age of onset, or severe hypoglycemia were found on visual or verbal memory over three years time. Conclusions: Of the risk factors studied, only poorer metabolic control had a significant impact upon visual memory after three years. Verbal memory was unaffected. However, given that level of metabolic control tends to remain relatively consistent over time, the effect of continued poorer metabolic control on memory should be monitored.     

Situation Taxonomy and Behavioral Diagnosis Using Prospective Self-Monitoring Data: Application to Dietary Adherence in Patients with Type 1 Diabetes

The goals of this study were to create a taxonomy of problem situations for diet adherence in persons with insulin-dependent diabetes mellitus (Type 1 diabetes) and a behavioral diagnosis by grouping patients together who have similar adherence problems. In study one, 29 patients with Type 1 diabetes kept food diaries for 4 weeks. Adherence was assessed using eight behavioral measures: (1) compliance with a meal plan, (2) energy intake, (3) protein, (4) carbohydrates, (5) fat, (6) self-reported overeating, (7) self-reported undereating, and (8) ratings of impulsive eating. The occurrence of each behavior was quantified in a wide range of situational contexts including meal, social context, physical location, and mood. Cluster analysis of behaviors, situations, and behaviors-in-situations was used to create a hierarchical classification model consisting of five major categories of adherence problems: (1) compliance with meal plan, (2) undereating, (3) overeating, (4) impulsive eating, and (5) lifestyle differences. Within each category, situations were associated with everyday eating habits and special circumstances such as social events, and meals in restaurants. Grouping patients based on the similarity of their adherence problems resulted in five diagnostic groups: (1) emotional binge eaters, (2) restrained eaters, (3) unrestrained eaters, (4) undereaters, and (5) cyclical diet bingers. In study two, 28 subjects kept diaries during an intervention program designed to enhance dietary adherence. Study two results were similar to study one. Situation taxonomy and behavioral diagnosis are potentially useful ways to understand the intervention needs of those attempting maintaining dietary behavior changes.