Metabolic control and psychological sense of control in women with diabetes mellitus. Alternative considerations of the relationship

Psychosocial factors in medication adherence and diabetes self-management: Implications for research and practice

Diabetes is a chronic illness that places a significant self-management burden on affected individuals and families. Given the importance of health behaviors-such as medication adherence, diet, physical activity, blood glucose self-monitoring-in achieving optimal glycemic control in diabetes, interventions designed and delivered by psychologists hold promise in assisting children, adolescents, and adults with diabetes in improving their health status and lowering their risk of serious complications. This article first provides an overview of diabetes self-management and associated challenges and burdens. Socioeconomic status factors that may influence diabetes management and outcomes are briefly highlighted. We then review the evidence base for select psychosocial factors that may be implicated in diabetes self-management. Modifiable targets of psychological intervention are presented across 3 overarching domains: (a) knowledge, beliefs, and related cognitive constructs; (b) emotional distress and well-being; and (c) behavioral skills and coping. Important methodological issues facing future research are discussed, along with opportunities for psychologists in improving the care and treatment outcomes of individuals and families living with diabetes. In conclusion, we advocate for continued research emphasis on improving psychosocial aspects of living with diabetes, with greater attention to the situational context in which the self-regulatory processes underlying self-management occur. Psychologists have important roles to play in reducing emotional distress, improving patient knowledge, and providing training in behavioral skills to promote successful self-management and to support patient-centered diabetes care. (PsycINFO Database Record

Control beliefs and risk for 4-year mortality in older adults: a prospective cohort study

BACKGROUND

Control beliefs are important psychological factors that likely contribute to heterogeneity in health outcomes for older adults. We evaluated whether control beliefs are associated with risk for 4-year mortality, after accounting for established "classic" biomedical risk factors. We also determined if an enhanced risk model with control beliefs improved identification of individuals with low vs. high mortality risk.

METHODS

We used nationally representative data from the Health and Retirement Study (2006-2012) for adults 50 years or older in 2006 (n = 7313) or 2008 (n = 6301). We assessed baseline perceived global control (measured as 2 dimensions-"constraints" and "mastery"), and health-specific control. We also obtained baseline data for 12 established biomedical risk factors of 4-year mortality: age, sex, 4 medical conditions (diabetes mellitus, cancer, lung disease and heart failure), body mass index less than 25 kg/m2, smoking, and 4 functional difficulties (with bathing, managing finances, walking several blocks and pushing or pulling heavy objects). Deaths within 4 years of follow-up were determined through interviews with respondents' family and the National Death Index.

RESULTS

After accounting for classic biomedical risk factors, perceived constraints were significantly associated with higher mortality risk (third quartile scores odds ratio [OR] 1.37, 95% CI 1.03-1.81; fourth quartile scores OR 1.45, 95% CI, 1.09-1.92), while health-specific control was significantly associated with lower risk (OR 0.69-0.78 for scores above first quartile). Higher perceived mastery scores were not consistently associated with decreased risk. The enhanced model with control beliefs found an additional 3.5% of participants (n = 222) with low predicted risk of 4-year mortality (i.e., 4% or less); observed mortality for these individuals was 1.8% during follow-up. Compared with participants predicted to have low mortality risk only by the classic biomedical model, individuals identified by only the enhanced model were older, had higher educational status, higher income, and higher prevalence of diabetes mellitus and cancer.

CONCLUSION

Control beliefs were significantly associated with risk for 4-year mortality; accounting for these factors improved identification of low-risk individuals. More work is needed to determine how assessment of control beliefs could enable targeting of clinical interventions to support at-risk older adults.

Predictor effect of Locus Of Control (LOC) on self-care activities and metabolic control in individuals with type 2 diabetes

Background

Previous studies have examined the role of individuals’ personal characteristics in diabetes management and used the locus of control theory to assess adherence to a diabetes management regimen. These studies have emphasized that having internal locus of control may be a protective factor in diabetes management.

Objective

The purpose of this study is to determine the predictor effect of locus of control on self-care activities and A1c level.

Method

The study is descriptive and relational. Researchers used a Diabetes Self-Care Activities Scale and a Locus of Control Scale to collect data. The study sample consisted of 129 individuals with type 2 diabetes.

Results

The average score of locus of control of individuals with diabetes was 10.26, and the frequency of self-care activities in the past week was 2.9 days. A weak but statistically significant negative relation was found between the locus of control level and self-care activities of individuals with diabetes, which had no effect on A1c. It was determined that locus of control predicts 19% of self-care activities.

Conclusion

According to the study results, having internal locus of control had positive effects on self-care activities. Training and planning activities to improve internal locus of control can improve diabetes management.

Predicting Medical Regimen Adherence: The Interactions of Health Locus of Control Beliefs

The present study examined the interactions between five dimensions of health locus of control beliefs and their relationships with medical regimen adherence in low-income individuals diagnosed with type 2 diabetes. One hundred and nine patients were administered an expanded Multidimensional Health Locus of Control (MHLC) scale. HbA1c was used as a biological indicator of medical regimen adherence. Multivariate regression analyses demonstrated that three interactions were significantly related to HbA1c. The present findings suggest that HLOC may be meaningfully related to medical outcomes. However, these relationships may not be captured through the examination of main effects and may be only found when interactions are considered.

Exploring the Connection Between Self-Efficacy and Effective Diabetes Self-f Management

PURPOSE

the purpose of this study was to review the existing empirical evidence about factors that contribute to effective diabetes self-management as indicated by healthy outcomes in persons with the disease, with a specific focus on self-efficacy, to determine the link between learned self-efficacy and effective diabetes self-management in adults.

METHODS

A systematic review was conducted of the extant literature from 1985-2001 that described factors related to effective self-management of diabetes. The review included theoretical and empirical articles. The search engines included CINAHL, MEDLINE, PUBMED, and COCHRANE.

RESULTS

Empirical evidence supports the following factors to improve the education outcomes for adults with diabetes: involve people with diabetes in their own care, guide them in actively learning about the disease, explore their feelings about having the disease, and teach them the skills necessary to adjust their behavior to control their own health outcomes. Thus, the goal for educating people with diabetes is to improve their individual self-efficacy and, accordingly, their self-management ability.

CONCLUSIONS

Education sessions need to involve fewer lectures and more practical, interactive exercises that focus on developing specific skills. Follow-up contact is a valuable method for helping people make a healthy adjustment to living with diabetes.

Control Beliefs and Risk for Death, Stroke and Myocardial Infarction in Middle-aged and Older Adults: An Observational Study

BACKGROUND

Chronic health conditions account for the largest proportion of illness-related mortality and morbidity as well as most of healthcare spending in the USA. Control beliefs may be important for outcomes in individuals with chronic illness.

OBJECTIVE

To determine whether control beliefs are associated with the risk for death, incident stroke and incident myocardial infarction (MI), particularly for individuals with diabetes mellitus (DM) and/or hypertension.

DESIGN

Retrospective cohort study.

PARTICIPANTS

A total of 5,662 respondents to the Health and Retirement Study with baseline health, demographic and psychological data in 2006, with no history of previous stroke or MI.

MAIN MEASURES

Perceived global control, measured as two dimensions--"constraints" and "mastery"--and health-specific control were self-reported. Event-free survival was measured in years, where "event" was the composite of death, incident stroke and MI. Year of stroke or MI was self-reported; year of death was obtained from respondents' family.

KEY RESULTS

Mean baseline age was 66.2 years; 994 (16.7%) had DM and 3,023 (53.4%) hypertension. Overall, 173 (3.1%) suffered incident strokes, 129 (2.3%) had incident MI, and 465 (8.2%) died. There were no significant interactions between control beliefs and baseline DM or hypertension in predicting event-free survival. Elevated adjusted hazard ratios (HRs) were associated with DM (1.33, 95 % CI 1.07-1.67), hypertension (1.31, 95% CI 1.07-1.61) and perceived constraints in the third (1.55, 95% CI 1.12-2.15) and fourth quartiles (1.61, 95% CI 1.14-2.26). Health-specific control scores in the third (HR 0.78, 95% CI 0.59-1.03) and fourth quartiles (HR 0.70, 95% CI 0.53-0.92) were protective, but only the latter category had a statistically significant decreased risk. Combined high perceived constraints and low health-specific control had the highest risk (HR 1.93, 95% CI 1.41-2.64).

CONCLUSIONS

Control beliefs were not associated with differential risk for those with DM and/or hypertension, but they predicted significant differences in event-free survival for the general cohort.

Adolescent sense of control: a downward extension of the Shapiro Control Inventory to pre- and early adolescents

The most commonly used measures of perceived control for young adolescents are dated, psychometrically flawed, or focused on particular domains. To address the need for a general purpose measure of control for this age range, the overall sense of control (OSOC) and the domains of control (DOC) subscales of the Shapiro Control Inventory (D. H. Shapiro, 1994), designed for use with adults, were modified. Exploratory factor analyses suggested that the adapted OSOC and DOC scales consisted of internally consistent 1-factor structures, accounting for 32% and 29% of the variance, respectively. In Study 1, results from 310 preadolescents (9-13 years old) indicated that a higher sense of control was related to lower stress, OSOC, r(308) = -.52, p < .001; DOC, r(308) = -.23, p < .001; and depression, OSOC, r(308) = -.63, p < .001; DOC, r(308) = -.33, p < .001. In study 2, results from 195 adolescents (11-15 years old) showed that a higher sense of control was associated with lower stress, r(193) = -.55, p < .001, and depression, r(193) = -.60, p < .001, concurrently. The results suggest that these 2 revised measures of adolescent perceived control exhibited good content and predictive validities.

Gender differences in diabetes self-management among African American adults

The rising incidence of diabetes complications among African Americans is a major health concern. Few studies have addressed gender differences in diabetes self-management in this population. The purpose of this study was to determine whether gender differences in facilitators and barriers to self-management exist among African American adults with type 2 diabetes. Thirty-eight participants were recruited from community agencies and each participated in one of seven audio-recorded focus group sessions. Regular health care visits, positive outlook, prioritization of health, and independence facilitated self-management behaviors in men, whereas acceptance of diabetes was a facilitator for women. Lack of time at work, lack of family support, and lack of knowledge were barriers for men, whereas lack of finances, embarrassment, negative outlook, perceived lack of disease control, and adverse effects of medications were barriers for women. Further research is necessary to design and test gender-specific tailored interventions to improve diabetes self-management in this population.

Sense of control and sociodemographic differences in self-reported health in older adults

PURPOSE

Stronger sense of control has been associated with improved health outcomes. This study tested whether the association between sense of control and self-reported health varied among demographic groups and whether sense of control attenuated sociodemographic differences in self-reported health.

METHODS

Data from 6,815 participants in the Health and Retirement Study were used to examine moderation between demographic characteristics and sense of control (measured by the personal mastery and perceived constraints scales of the midlife developmental inventory) in their associations with three self-reported health measures (global rating of fair/poor health, functional limitations, and number of comorbid conditions).

RESULTS

Higher personal mastery and lower perceived constraints were associated with better self-reported health. There were no significant interactions between the sense of control measures and age, gender, education level, income, or marital status in their associations with either global self-rated health or functional limitations. Higher levels of mastery were associated with lower likelihood of functional limitations among blacks and whites, but not among those of other races. Perceived constraints were slightly more strongly associated with number of comorbid conditions among older than younger individuals.

CONCLUSIONS

Sense of control measures were generally similarly associated with self-reported health across demographic groups and did not attenuate demographic differences in health.

The impact of perceived stress and perceived control on anxiety and mood disorders in noncardiac chest pain

Chest pain without detectable heart disease, noncardiac chest pain (NCCP), is linked with anxiety and depression. Theory posits stress and perceived control may relate to NCCP. We hypothesized stress would have direct and mediated effects via perceived control on anxiety and mood disorders in NCCP. Patients ( N = 113) completed questionnaires and a structured diagnostic interview. Stress and perceived control were associated with anxiety and mood disorder severity. Perceived control fully mediated the relation between stress and mood disorder severity but not anxiety disorder severity. Results are partially supportive of anxiety-based theories of NCCP.

Toward a more complete understanding of the effects of personal mastery on cardiometabolic health

OBJECTIVE

A great deal of research has been devoted to identifying the psychological factors that might be associated with reduced risk for cardiovascular diseases. In particular, coping resources such as personal mastery might attenuate stress-related pathophysiology. The purpose of the present review was to examine the existing literature reporting associations between personal mastery and cardiometabolic health outcomes to determine which outcomes have been studied to date, investigate the extent of inconsistency in the literature, and propose new directions for research.

DESIGN

Systematic review of articles examining the associations between personal mastery and cardiometabolic health.

MAIN OUTCOME MEASURES

Studies were included if they examined objective measures of cardiometabolic function, cardiovascular events, and/or mortality.

RESULTS

Thirty-two studies were identified examining the effect of mastery on the following outcomes: mortality and/or cardiovascular events, psychoneuroendocrine stress systems, cardiovascular reactivity to acute stress, metabolic dysregulation, inflammation/coagulation, and evidence of large vessel disease from imaging methods.

CONCLUSIONS

Overall, mastery was associated with better cardiometabolic health and reduced risk for disease and/or death, typically with a small-medium effect size. A relatively small proportion of studies reported contradictory findings that higher mastery was associated with poorer cardiometabolic outcomes. The state of the current research suggests that future investigations should focus on 1) clarifying the mediators and moderators most relevant in the association between mastery and downstream disease, 2) testing the association between mastery and biological outcomes longitudinally, 3) examining the physiological impact of mastery-increasing interventions, and 4) studying the relationship between mastery and disease risk in diverse ethnic or sociocultural groups.

Relationships between locus of control and adherence to diabetes regimen in a sample of Iranians

Background:

Adequate self-care in diabetes improves quality of life and decreases the number of inpatient cases. The health locus of control theory is used to assess adherence to diabetes regimen in some studies in developed countries. The primary purpose of this cross-sectional study is to determine the status of diabetes locus of control in a sample of diabetic patients in Iran as a developing country. We investigated selected factors contributing to locus of control and adherence to diabetes regimen.

Materials and Methods:

This cross-sectional study was carried out on 120 patients referred to Yazd Diabetes Research Center. The Iranian versions of Diabetes Locus of Control scale and Diabetes Self-care Activities scale were used for data collection.

Results:

Men revealed more internal locus of control and women revealed more chance locus of control. The attributions of external locus of control increased by age, while the internal locus of control increased by education level and chance locus of control decreased by education level. A positive association between internal locus of control and adherence to diabetes regimen was found and there was a negative association between chance locus of control and adherence to diabetes regimen.

Conclusion:

Findings suggest that interventions aimed at improving internal locus of control may improve adherence to diabetes regimen but different diabetic patients have different attribution styles and interventional programs to enhance diabetes self-care will be more successful if patient's locus of control is addressed.

Effect evaluation of a Motivational Interviewing based counselling strategy in diabetes care

AIM

The present study assessed the effects of a Motivational Interviewing (MI) based counselling training for nurses on clinical, behavioural and process outcomes among diabetes type 2 patients.

METHODS

The study is an RCT with follow-up measurements after 12 and 24 months. Thirty-three nurses and 584 patients participated. Nurses in the experimental condition received the training; control group nurses were trained after the study. The training consisted of two training sessions, two follow-up meetings, written feedback and three direct feedback sessions. Basic MI-principles and techniques and an MI-based counselling protocol were addressed.

RESULTS

Results indicated disadvantageous effects on fat intake and HDL and advantageous effects on chance locus of control and knowledge. No effects were found on vegetable or fruit intake, physical activity, HbA1c, weight, blood pressure, total cholesterol, LDL, triglycerides, health care climate, quality of life or on self-efficacy.

CONCLUSIONS

As in other MI studies, mixed results were found. It would be premature to recommend dissemination of MI in diabetes care. More studies are needed in real-world settings with health care professionals of the field instead of intensively trained MI interventionists. Knowledge should be gained about adequate training and factors contributing to the implementation of MI in daily practice.

Facilitators and Barriers to Self-management of Type 2 Diabetes Among Urban African American Adults

Purpose

The purpose of this study was to identify facilitators and barriers to self-management of type 2 diabetes mellitus (T2DM) among urban African American adults.

Methods

Thirty-eight African American adults with T2DM were recruited from 1 of 3 health care agencies in a midsized city in the southeastern United States. Qualitative data were obtained using focus groups, wherein each participant engaged in a 60- to 90-minute audio-recorded session. Focus group data were transcribed and analyzed using Atlas ti 6 ® data analysis software. Demographic and medical history information was also collected.

Results

Factors relating to external locus of control primarily facilitated adherence to T2DM self-management behaviors. Support from family, peers, and health care providers positively influenced adherence behaviors by providing cues to action, direct assistance, reinforcement, and knowledge. Internal factors were primarily described as barriers to self-management behaviors and included fears associated with glucose monitoring, lack of self-control over dietary habits, memory failure, and perceived lack of personal control over diabetes.

Conclusions

African Americans perceived external factors as facilitators of their T2DM management behaviors and internal factors as barriers to self-management. Further research is necessary to design and test interventions that capitalize on the external facilitators while helping African Americans to overcome perceived barriers identified in this study.

The Effect of a Diabetes Education, Coping Skills Training, and Care Intervention on Physiological and Psychosocial Outcomes in Black Women With Type 2 Diabetes

An 11-week culturally relevant group diabetes self-management training (DSMT), coping skills training (CST), and diabetes care intervention was compared to a 10-week usual diabetes education and diabetes care intervention on physiological and psychosocial outcomes in 109 Black women (aged 48 ± 10 years) with type 2 diabetes in primary care (PC). Strong time effects for hemoglobin A1c improvement were seen in both groups from baseline to 3 months and remained similar at 12 and 24 months (p < .0001). Systolic blood pressure (p =.01) and low-density lipoprotein cholesterol levels (p = .05) improved in both groups from baseline to 24 months. Baseline quality of life ([QOL]; Medical Outcome Study Short Form-36) was low. Social function, role-emotional, and mental health domains increased initially in both groups then declined slightly, with less decline for the experimental group at 12 months. At 24 months, experimental group scores increased. General health (p = .002), vitality (p = .01), role-physical, and bodily pain (p = .02) domains increased in both groups over time. Perceived provider support for diet (p = .0001) and exercise (p = .0001) increased in both groups over time. Diabetes-related emotional distress decreased in the experimental compared to the control group (group x time, p = .01). Findings suggest that both methods of diabetes education combined with care can improve metabolic control, QOL, and perceptions of provider care. CST may further assist in long-term improvements in health outcomes. Behavioral interventions are needed in addition to routine diabetes care, particularly in PC.

Sense of mastery and metabolic risk: moderating role of the local fast-food environment

OBJECTIVE

To test the moderating role of the extent of fast-food restaurants in one's immediate environment in the association between mastery and metabolic risk. Higher sense of mastery (perceived control over one's circumstances) has been associated with better metabolic outcomes. Mastery may be instrumental in resisting unhealthful environmental food cues when these become ubiquitous, resulting in a greater health impact of mastery.

METHODS

Blood samples were obtained from 344 individuals (50% men), aged 18 to 57 years (mean, 34.9 years), sampled from seven census tracts representing the spectrum of census tract-level socioeconomic status and language (French/English) in Montreal. Risk factors based on standards for high-density lipoprotein and total cholesterol, waist circumference, body mass index, triglycerides, and glycated hemoglobin were summed to obtain a cumulative metabolic risk score. Mastery was self-reported, using a validated scale. The proportion of restaurants classified as fast-food within 500 m of participants' residences was determined, using a geographic information system. Main and interactive effects were tested with Poisson regression, accounting for clustering of observations and participants' age, gender, education, and income.

RESULTS

Mastery interacted with fast-food exposure in relation to metabolic risk (p = .03). Higher mastery was significantly associated with lower metabolic risk for participants surrounded by a high proportion of fast food (relative risk, 0.80; 95% confidence interval, 0.76-0.84; p < .0001), but not for those living in areas with low proportion of fast-food restaurants (relative risk, 0.94; 95% confidence interval, 0.82-1.08; p = .37).

CONCLUSIONS

A positive relationship between mastery and lower metabolic risk was most apparent in environments with higher fast-food exposure.

Sense of control and diabetes mellitus among U.S. adults: a cross-sectional analysis

Background

Little is known about the influence of psychosocial factors on diabetes mellitus. The aim of this study was to improve understanding of the association between two psychosocial factors- sense of control and social support- and diabetes mellitus.

Methods

The authors analyzed data from 2,592 U.S. households in the 1995 survey of the Aging, Status, and the Sense of Control study. Logistic regression analyses were conducted to examine whether sense of personal control and social support were associated with DM and whether gender, race, and Hispanic ethnicity modified these associations.

Results

After adjusting for age, obesity, and socioeconomic position, a one point increase in sense of control (i.e., a stronger sense of control) was associated a significant reduction in risk of diabetes mellitus (odds ratio = 0.67, 95% confidence interval: 0.47, 0.95). A weak social support system was associated with a non-significant risk of diabetes (odds ratio = 1.32, 95% confidence interval: 0.93, 1.89). No effect modification was detected.

Conclusion

Sense of control deserves greater attention as a predictor of diabetes mellitus. Further studies of the contribution of psychosocial factors to diabetes mellitus should assess the temporal nature of this relationship.

Control and disordered eating in type 1 diabetes

Control is a major topic associated with the management of diabetes due to the importance placed on maintaining healthy blood glucose levels in this condition. Such an outcome can be influenced by individuals' sense of mastery over the disease, and more generally over their environment. In response to a diagnosis of diabetes, the self-management requirements accompanying it, and/or difficulties in other areas of life, patients may decide to undertake behaviours that are detrimental to their well-being. For instance, they may adopt fixated attitudes towards their intake and weight. This paper explores the relationship between disordered eating habits, control and diabetes in those who are insulin dependent.

Eating disorders across two cultures: does the expression of psychological control vary?

OBJECTIVE

Because both the expression of eating disorder (ED) symptoms and preferred psychological control styles may be affected by culture, the purpose of the present study was to examine whether the expression of psychological control in women with EDs varies across two cultures.

METHOD

North European Australian and Chinese Singaporean women (n = 117) with anorexia nervosa (n = 36), bulimia nervosa (n = 13) and eating disorders not otherwise specified (n = 3), and without an ED (n = 65) recruited in Australia and Singapore completed a multidimensional inventory assessing sense of control, domains of control, preferred means by which to gain control, and motivation for control.

RESULTS

Although the normative control profile for each culture differed slightly, control profiles among those with an ED were very similar across both cultures. However, the directionality and extent of specific aspects of control pathology associated with the presence of an ED differed across cultures. North European Australians with an ED were much more deviant from the cultural norm than their Chinese Singaporean ED counterparts in relation to overall sense of control, methods of gaining control, and control in the domain of body. Chinese Singaporean woman with an ED were much more deviant from the cultural norm than their North European Australian ED counterparts in the domain of control over impulses.

CONCLUSIONS

Having an ED powerfully distorts psychological control irrespective of culture. However the degree, directionality, and form of the displacement from normal control styles is also culture dependent. This has implications for treatments that attempt to redress or correct control issues in people with an ED in other cultures.

One-year follow-up effects of diabetes rehabilitation for patients with prolonged self-management difficulties

The aim of this study is to determine effects and the role of facilitators of empowerment of a Multidisciplinary Intensive Education Programme (MIEP) for diabetic patients with prolonged self-management difficulties. Glycemic control (HbA1c), health-related quality of life (HR-QoL) and facilitators of empowerment (health locus of control and coping) were measured in 99 participants of MIEP at baseline (T0), 3 (T1) and 12 months (T2) follow-up and in 231 non-referred consecutive outpatients. HbA1c improved at T2, although initial improvement was partially lost. Patients improved in most HR-QoL domains, without any relapse at T2. At T2, participants no longer differed from the average outpatients in any outcome. Initially, the HbA1c of men and women improved equally, but at T2 women consolidated improvement, whereas men relapsed. After MIEP, patients became more empowered (both at T1 and T2), explaining additional variance in HR-QoL improvement. The aim of MIEP to empower patients, rather than trying to solve problems for them seems effective.

Self-management in African American women with diabetes

PURPOSE

This study describes demographic and medical characteristics, self-efficacy, locus of control, self-management defined by functional status, hemoglobin HbA1c outcomes, and the relationships among these variables based on age group differences (25-44 years, 45-64 years, and 65-84 years) in African American women with type 2 diabetes.

METHODS

Subjects (n = 75) in community medical practices were interviewed to complete a demographic and medical form, the Diabetes Self-efficacy Outcomes Expectancy Questionnaire (DSEQ), the Diabetes Locus of Control Scale, and the Medical Outcomes-Short Form 36 (SF-36). A venous blood sample was taken following the interview. Data were analyzed for the total sample and separately for age groups.

RESULTS

Scores on the self efficacy (DSEQ) and the locus of control (LOC) were above average for all 3 groups. Significant correlations were found among subscales of the LOC, SF-36, and HbA1c. HbA1c scores were abnormally high across groups. Significant group differences were found in duration of diabetes and number of medications used.

CONCLUSIONS

Despite high levels of internal locus of control and self-efficacy and scores indicating good mental, physical, emotional, and social health, self-management among the women was inadequate, as indicated by abnormally high HbA1c levels.

Disturbed eating attitudes, coping styles, and subjective quality of life in adolescents with Type 1 diabetes

OBJECTIVES

To evaluate coping styles and quality of life in youth with Type 1 diabetes with and without eating disorders and to identify relationships between these variables in each group.

METHODS

Adolescents were evaluated for eating disorders with a two-stage diagnostic procedure. Adolescents with and without eating disorders then provided data on coping styles and on subjective well-being.

RESULTS

Adolescents with Type 1 diabetes and disordered eating behavior reported more often blaming themselves and resorting to wishful thinking and poorer physical and psychosocial quality of life than do adolescents with Type 1 diabetes without disordered eating behavior. Specific coping strategies were also positively linked with quality of life and metabolic control.

CONCLUSIONS

Eating disorders and disordered eating behavior in adolescents with Type 1 diabetes seem to be associated with certain negative and avoidant coping strategies and with impeded physical and bio-psychosocial well-being.

Relationship between control and the intermediate term outcome of anorexia nervosa in Hong Kong

OBJECTIVE

To examine the relationship between control and the intermediate term outcome of Chinese patients with anorexia nervosa.

METHOD

88 patients who fulfilled the DSM-III-R criteria for typical (fat phobic, n=63) and atypical (non-fat phobic, n=25) anorexia nervosa were contacted 9 years after the onset of illness. They completed the Morgan-Russell Outcome Assessment Schedule, Shapiro Control Inventory, and Eating Disorder Inventory-I.

RESULTS

62.2%, 32.4% and 5.4% of patients had good, intermediate, and poor outcome. Outcome was positively correlated with the overall general and specific sense of control, positive sense of control, and negatively with negative sense of control. Patients with good outcome exhibited the least negative modes of control and had the least desire for control. Typical and atypical patients showed similar but not identical control profiles.

CONCLUSION

Healthier control was associated with better outcome of anorexia nervosa but their causal relationship was far from clear because of the cross-sectional nature of the present study. The Shapiro Control Inventory is a potentially useful instrument for studying control in eating disorders.

Personal control and disordered eating in female adolescents with type 1 diabetes

OBJECTIVE

The onset and subsequent management of diabetes can challenge one's sense of control. Sense of control can also be affected by the biological changes accompanying normal pubertal development. The negative impact on one's sense of control may be further exacerbated when both events (i.e., diabetes and puberty) occur in relatively close temporal proximity.

RESEARCH DESIGN AND METHODS

This study examined the relationship between sense of control and disordered eating and glycemic control in 45 female adolescents with type 1 diabetes.

RESULTS

A lower sense of overall control and a lower sense of bodily control were both directly related to more severe eating-disordered symptoms. However, a lower sense of overall control and lower bodily control were related to poorer metabolic control primarily when the diagnosis of diabetes occurred closer to the onset of puberty.

CONCLUSIONS

Clinicians should assess and monitor perceptions of control and also consider the temporal proximity of disease onset and onset of puberty when managing type 1 diabetes in female adolescents.

Links between psychological sense of control and disturbed eating behavior in women with diabetes mellitus. Implications for predictors of metabolic control

PURPOSE

Eating disturbances and aspects of psychological control are both repeatedly cited as significant correlates of metabolic control in diabetes mellitus (DM), yet such findings are typically discussed in separate literatures and have been criticized for overreliance on outdated constructs of psychological control when more complex means of analysis are available.

METHODS

Utilizing a multidimensional control inventory, this study investigates the relationship between eating disturbance and psychological sense of control, and assesses the utility of these two constructs in predicting metabolic control in 96 women recruited from a specialist diabetes clinic.

RESULTS

Despite significantly overlapping relationships between these two predictor variables and metabolic control, it is control specific to the domain of interpersonal relationships, along with eating disturbance in the form of bulimia/food preoccupation, that independently predicts level of metabolic control.

CONCLUSIONS

These findings have implications for the current form and content of psychological interventions in the management of DM.