HbA1c levels as a function of emotional regulation and emotional intelligence in patients with type 2 diabetes

The Association between Personality Factors and Metabolic Parameters among Patients with Non-Alcoholic-Fatty Liver Disease and Type 2 Diabetes Mellitus-A Cross-Sectional Study

BACKGROUND

The increasing prevalence of type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) states a serious problem for public health. The introduction of effective methods of treatment and prevention is crucial to avoid complications of these diseases. Among them, we can specify psychological factors that affect everyday life and determine the patient's attitude towards therapy, and what follows, their compliance in treatment. The literature indicates these connections in various ways; in our study, we extend this view to include a broader perspective of human personality.

OBJECTIVE

We decided to investigate the associations between personality factors and metabolic parameters in patients with NAFLD and T2DM in order to better understand the patient's approach to the treatment of a chronic disease, such as those mentioned, and to establish the basis for further research implementing psychological interventions in the treatment of NAFLD and T2DM.

METHODS

One hundred participants with NAFLD and T2DM underwent blood tests and anthropometric measures. Each of them was asked to complete five questionnaires evaluating their personality properties.

RESULTS

We revealed that a rise in body mass index is related to a fall in the emotional intelligence factor of utilizing emotions, and a rise in emotional perception. The decrease in task-oriented coping style and a rise in emotion-oriented coping style are associated with a waist-hip ratio increase. The increase in fasting plasma glucose is predicted by a decrease in task-oriented coping style score. A fall in social diversion coping style score is associated with a high-density lipoprotein increase; in turn, a triglycerides increase is connected with a decline in rhythmicity score.

CONCLUSIONS

The personality factors are in relationship in the management of NAFLD and T2DM. They affect a patient's approach to treatment, which is very important, because we know lifestyle and dietary interventions are an important part of the treatment of these diseases. The compliance manifests by lifestyle modifications, taking medications regularly, measuring blood glucose, and inspection visits in outpatients' clinics are a large part of a diabetic's life. Future studies introducing psychological intervention to improve, e.g., coping styles or rhythmicity are needed to implement new methods of patient management.

Influence of emotional intelligence on glycemic control in adolescents with diabetes type 1

INTRODUCTION

Psychological factors can have a significant impact on diabetes control. We aimed to evaluate the correlation between emotional intelligence and glycemic control in type one diabetes (T1D) adolescents.

MATERIAL AND METHODS

This prospective study enrolled 97 consecutive children admitted to our department and aged 15 to 17 with T1D. The Emotional Intelligence Questionnaire INTE was used to measure emotional intelligence. The results were correlated with a glycemic control status, measured by current and mean (since the diagnosis of T1D, minimum four tests per year) and hemoglobin A1c (HbA1c). An additional questionnaire collected the demographic and social data.

RESULTS

Our study found a significant, negative correlation between HbA1c level and the ability to utilize emotions to support thinking and actions (Factor I of the INTE questionnaire). There was no significant correlation between emotional intelligence General Score or Factor II (the ability to recognize emotions) and glycemic control.

CONCLUSIONS

A higher ability to utilize emotions to support thinking and actions positively correlates with metabolic control in the adolescent population with T1D. The appropriate emotional intelligence training and better psychological care may improve the metabolic outcomes of children with T1D. This merits further study.

Diabetes distress, emotional regulation, HbA1c in people with diabetes and A controlled pilot study of an emotion-focused behavioral therapy intervention in adults with type 2 diabetes

AIM

One potential barrier for people with diabetes to reach glycemic goals is diabetes distress. Accumulating evidence suggests diabetes distress may be linked to individuals' emotion regulation capacities. Thus, we conducted two studies to elucidate a model for how emotion regulation impacts diabetes distress and A_1c levels and determine preliminary effect size estimates for an intervention targeting poor emotion regulation on glycemic control.

METHODS

Study I used structural equation modeling to assess the cross-sectional relationships between these variables in a sample of 216 individuals with Type 1 and Type 2 diabetes. Study II built on findings from Study I that highlighted the role of emotion regulation capacities in diabetes distress and A_1c by conducting a pilot study of an emotion-focused behavioral intervention compared to treatment as usual in a sample of individuals with Type 2 diabetes.

RESULTS

Study I examined two potential explanatory models with one of the models (Model II) showing a more comprehensive view of the data revealing a total effect of poor emotional regulation of 42% of all effects on A_1c levels. Study II tested an emotion-focused behavioral intervention in patients with Type 2 diabetes compared to treatment as usual and found medium sized reductions in A_1c levels and smaller reductions in diabetes distress that correlated with changes in emotion regulation.

CONCLUSIONS

These studies suggest that, in people with diabetes, elevated A_1c levels and diabetes distress are linked with poor emotion regulation. While the effect sizes from Study 2 are preliminary, an emotion-focused behavioral intervention may reduce both A_1c and diabetes distress levels, through improvements in emotion regulation. Overall, these data suggest that targeting difficulties in emotion regulation may hold promise for maximizing improvement in diabetes distress and A_1c in individuals with diabetes.

The cardiac autonomic response to acute psychological stress in type 2 diabetes

Background

Impaired cardiac autonomic control is common among people with type 2 diabetes. The autonomic nervous system and its regulatory influence on the cardiovascular system also play a key role in the physiological response to psychosocial stressors. It is unclear whether the disease-related impairment of cardiac autonomic control in people with type 2 diabetes affects the stress response. The aim of this study was therefore to examine the cardiac autonomic and the psychological stress response of people with type 2 diabetes compared to healthy control participants.

Methods

We used the trier social stress test to induce stress in n = 51 participants with type 2 diabetes and n = 47 healthy controls. We assessed heart rate (HR) and heart rate variability (HRV) using six ECG samples before, during and after the stress test. We measured participants’ psychological stress response using visual analogue scales.

Results

Longitudinal multilevel models showed an attenuated HR increase in response to the stress test combined with a slower HR recovery after the stress test, in people with type 2 diabetes. This pattern was accompanied by significantly lower low frequency HRV but no differences in high frequency HRV between the groups. Additionally, people with type 2 diabetes showed an increased level of self-reported psychological tension 45 minutes after the stress test.

Conclusions

The impairment of the autonomic nervous system found in people with type 2 diabetes is reflected in the HR response to stress—but not in the HRV response—and partially mirrored in the psychological stress response. Our results underline the importance of considering the interplay of psychosocial stress and disease-related changes in the physiological stress response system in research and treatment of type 2 diabetes.

Variation in Patient-Described Barriers to and Facilitators of Diabetes Management by Individual-Level Characteristics: A Cross-Sectional, Open-Ended Survey

This study analyzed patient-described barriers and facilitators related to diabetes management, focusing on how these differ by glycemia and across individual characteristics. A cross-sectional telephone survey was conducted with adult patients with diabetes in Alberta, Canada, asking two open-ended questions to describe the most helpful and difficult components of their diabetes management. Responses were analyzed using directed content analysis using the Theoretical Domains Framework as a template. The most frequently cited facilitator was care context and information, and the most frequently cited barriers were cognitive challenges and structural barriers, with patient-perceived barriers and facilitators varying by individual-level factors.

The Relationship Between Emotional Intelligence and Diabetes Management: A Systematic Review

Diabetes has been associated with affective disorders which complicate the management of the disease. Emotional intelligence (EI), or the ability to perceive, facilitate, understand, and regulate emotions, has shown to be a protective factor of emotional disorders in general population. The main objective of this study was to systematically review the role of the EI construct in Type 1 and Type 2 diabetics and to observe how EI is related to biological and psychological variables. Comprehensive searches were conducted in PubMed, Scopus, PsycInfo, and Cochrane without time limitations, for studies examining the link between diabetes and EI. A total of 12 eligible studies were selected according to the inclusion criteria. We divided the results into four sections: (1) EI and hemoglobin glycosylated (HbA1c), (2) EI training effects, (3) differences in EI between persons with diabetes and without diabetes, and (4) EI and psychological adjustment and well-being. The results showed negative correlations between EI and HbA1c, positive effects of EI training on quality of life, anxiety, and glycemic control, no differences in EI between people with diabetes and healthy individuals, and, finally, negative correlations between EI and different psychological variables such as diabetes-related anxiety and distress, and positive correlations with quality of life, well-being, and marital satisfaction. This systematic review offers a starting point for a theoretical and practical understanding of the role played by EI in the management of diabetes and reveals that EI is a promising protective factor for biological and psychological variables in this population.

Emotional Regulation and Diabetes Distress in Adults With Type 1 and Type 2 Diabetes

OBJECTIVE

To explore the correlates of diabetes-related distress (DD) with psychometrically valid assessments of emotional regulation in individuals with type 1 and type 2 diabetes.

RESEARCH DESIGN AND METHODS

Adults with diabetes (n = 298) were assessed for psychological issues possibly associated with diabetes and were further evaluated with measures of negative emotional experience (ER-Exp) and skill at regulating such experiences (ER-Skill) and measures of DD, perceived psychosocial stress, diabetes literacy, and diabetes self-care.

RESULTS

ER-Exp was directly related to DD, while ER-Skill was inversely related to DD. Together, these ER variables displayed a medium-size relationship (β = 0.45) with DD. Inclusion of variables related to diabetes self-care and perceived psychosocial stress was associated with only an 18% reduction (i.e., β = 0.45 to β = 0.38) in the strength of this relationship, while the magnitude of relationships between DD and perceived psychosocial stress (β = 0.15) and diabetes self-care (β = -0.09) was relatively small.

CONCLUSIONS

These data suggest that DD is meaningfully linked with negative emotionality, and skill at regulating such emotions, in adults with diabetes. This relationship appears to be stronger than that between DD and perceived psychological stress or diabetes self-care. If so, DD (and possibly A1C) may be improved in those with diabetes and difficulties with negative emotionality.

Evidence for Mental Health Contributions to Medical Care in Diabetes Management: Economic and Professional Considerations

PURPOSE OF REVIEW

This paper considers the potential contributions of behavioral health providers to interprofessional, collaborative treatment for diabetes. We have the following objectives: (1) review the behavioral health complications, risks, burdens, and costs associated with diabetes management and consider the role of behavioral health providers in treating mental health concerns specific to diabetes; (2) highlight two frameworks for incorporating behavioral health into diabetes treatment, and review the empirical support for each; and (3) consider the financial feasibility of integrating behavioral health services into diabetes medical care settings.

RECENT FINDINGS

The healthcare field is still in the nascent stages of integrating behavioral health services in endocrinology clinics, but there is growing evidence that integrated behavioral healthcare has the potential to improve disease management and psychological functioning for individuals with chronic medical conditions. Furthermore, as a result of recent changes to the billing structure for behavioral health services in a medical setting, reimbursement rates for behavioral health providers in this capacity have improved considerably. If delivered by qualified behavioral health providers using evidence-based guidelines, behavioral health integration has the potential to optimize health outcomes, improve quality of life, and decrease fragmentation of care for patients with diabetes. Future research should focus on developing a financially feasible, empirically supported model of integrated behavioral health and disseminating the model to medical providers treating patients with diabetes.

The Profile of Emotional Competence (PEC): A French short version for cancer patients

BACKGROUND

Intrapersonal and interpersonal Emotional Competence (EC) predicts better health and disease adjustment. This study aimed to validate a short version of the Profile of Emotional Competence (PEC) scale for cancer patients.

METHODS

Five hundred and thirty-five patients with cancer completed a self-reported questionnaire assessing their intra- and interpersonal EC (PEC), their anxiety and depression symptoms (HADS), and their health-related quality of life (QLQ-C30). Confirmatory factor analyses and Item Response Theory models with the Partial Credit Model were performed to validate and reduce the scale.

FINDINGS

The Short-PEC (13 items), composed of 2 sub-scores of intra- (6 items) and interpersonal (7 items) EC, showed an improved factorial structure (Root Mean Square Error of Approximation (RMSEA) = 0.075 (90% confidence interval 0.066-0.085), comparative fit index = 0.915) with good psychometric properties.

DISCUSSION

Future studies should use the Short-PEC to explain and predict the adjustment of cancer patients. The short-PEC could be also used in clinical routine to assess the level of EC of patients and to adapt psychosocial intervention.

Depression prevalence in Type 2 diabetes is not related to diabetes-depression symptom overlap but is related to symptom dimensions within patient self-report measures: a meta-analysis

AIM

Depression is common in Type 2 diabetes, yet rates vary. Overlap between symptoms of depression and diabetes may account for this variability in depression prevalence rates. We examined to what extent depression prevalence was a function of the proportion of depression-diabetes symptom overlap (items within symptom dimensions) and sample characteristics.

METHODS

Electronic and hand searching of published and unpublished works identified 147 eligible papers. Of 3656 screened, 147 studies (149 samples, N = 17-229 047, mean sample age 25.4-82.8 years, with 152 prevalence estimates), using 24 validated depression questionnaires were selected. Sample size, publication type, sample type, gender, age, BMI, HbA_1c , depression questionnaire and prevalence rates were extracted.

RESULTS

Prevalence rates ranged from 1.8% to 88% (mean = 28.30%) and were higher in younger samples, samples with higher mean HbA_1c and clinic samples. Diabetes-depression symptom overlap did not affect prevalence. A higher proportion of anhedonia, cognition, cognitive, negative affect and sleep disturbance symptoms, and a lower proportion of somatic symptoms were consistently associated with higher depression prevalence.

CONCLUSIONS

The lack of an overall effect of diabetes-depression symptom overlap might suggest that assessment of depression in Type 2 diabetes is generally not confounded by co-occuring symptoms. However, questionnaires with proportionally more or fewer items measuring other symptom categories were associated with higher estimates of depression prevalence. Depression measures that focus on the cardinal symptoms of depression (e.g. negative affect and cognition), limiting symptoms associated with increasing diabetes symptomatology (e.g. sleep disturbance, cognitive) may most accurately diagnose depression.

The Role of Health Literacy in Diabetes Knowledge, Self-Care, and Glycemic Control: a Meta-analysis

BACKGROUND

Empirical evidence on how health literacy affects diabetes outcomes is inconsistent. The purpose of this meta-analysis was to quantitatively summarize the findings on the associations between health literacy and diabetes knowledge, self-care activities, and glycemic control as disease-related outcomes, with specific focus on the type of health literacy assessment.

DATA SOURCES

Nine databases (MEDLINE, CINAHL, Communication and Mass Media Complete, PsychInfo, PsychArticles, Psychology and Behavioral Sciences Collection, ERIC, Sociology, Embase) were searched for peer-reviewed original research articles published until 31 March 2018.

METHODS

Studies with type 1 and/or type 2 diabetes patients aged 18 or older, providing a calculable baseline effect size for functional health literacy and diabetes knowledge, self-care activities, or HbA1C were included.

RESULTS

The meta-analysis includes 61 studies with a total of 18,905 patients. The majority were conducted in the USA, on type 2 diabetes patients, and used the S-TOFHLA as a performance-based or the BHLS as a perception-based measure of functional health literacy. Meta-analytic results show that all three outcomes are related to health literacy. Diabetes knowledge was best predicted by performance-based health literacy measures, self-care by self-report measures, and glycemic control equally by both types of health literacy assessment.

DISCUSSION

Health literacy plays a substantial role in diabetes knowledge. Findings for the role of health literacy in self-care and glycemic control remain heterogeneous, partly due to the type of health literacy assessment (performance- vs. perception-based). This has implications for the use of health literacy measures in clinical settings and original research. This meta-analysis was limited to functional health literacy and, due to the paucity of studies, did not investigate the role of other dimensions including communicative and critical health literacy.

Emotional abilities and HbA1c levels in patients with type 1 diabetes

In recent years a growing body of research is focused on the relationships between emotions and health. When it comes to diabetes, findings suggest that distress might play a key role in the acquisition and maintenance of health habits associated with diabetic management. This report describes two studies examining the roles of emotional abilities in diabetic management from two different conceptual points of view using two culturally different samples. In study 1, we examined the relationship between emotional intelligence and HbA1c levels in a sample of eighty-five patients with type 1 diabetes mellitus (DM1) in Israel. In study 2, we examined the relationship between specific emotional regulation strategies and HbA1c in sixty-seven adolescents with DM1, while examining the mediating role of distress in this association. The results showed a negative association between emotional intelligence and HbA1c levels, even after controlling for potential intervening factors. We found that the relationship between difficulties in emotion regulation and HbA1c seemed to be mediated by diabetes-related distress. These findings may aid in the design of psychological models for future research as well as interventions aimed at improving emotional abilities in people with DM1.

Identification and regulation of emotions in adults of varying weight statuses

Comparing individuals of varying weight statuses on their identification and regulation of emotions may increase our understanding of mechanisms that drive excess weight gain and highlight more precise weight regulation targets. In Study I ( N = 1333), adults with obesity had reduced self-reported attention to and repair of emotions compared to adults with overweight or normal weight. In Study II ( N = 85), adults with obesity had deficits in assessor-administrated tasks of strategic emotional intelligence (i.e. understanding and using emotional information for self-management). Problems identifying and regulating emotions could impact emotion regulation processes that lead to problematic behaviors associated with eating and weight gain.