Attentional bias to diabetes cues mediates disease management improvements in a pilot randomized controlled trial for adolescents with type 1 diabetes

Cognitive Biases in Type 2 Diabetes and Chronic Pain

The aim of the present study was to investigate the role of cognitive processing biases in Type 2 diabetes (T2D) and chronic pain, 2 conditions that are highly co-morbid. The final sample comprised 333 individuals (86 with T2D and chronic pain, 65 with chronic pain, 76 with T2D, 106 without any form of diabetes or pain). Participants completed questionnaires assessing pain and diabetes-related outcomes, as well as measures of interpretation bias, attentional bias, and attentional bias variability. In a 2 (pain status) x 2 (T2D status) x 3 (bias valence) ANOVA design, interpretation biases were found to be stronger in individuals with chronic pain than individuals without pain, although there were no differences according to T2D status. No group differences in attentional biases were found. Among individuals with T2D, greater interpretation bias was associated with better blood glucose control, but also greater fear of hypoglycemia. For individuals with chronic pain, greater interpretation bias and attentional bias variability was associated with worse pain outcomes. Whilst interpretation bias may be present in chronic pain, it also appears to indicate better glycemic control in individuals with T2D. These findings suggest a more dynamic approach to understanding cognitive bias is needed, to consider when these biases are more or less adaptive, so that they can be better harnessed to improve outcomes for individuals with T2D who experience chronic pain. PERSPECTIVE: These findings suggest that cognitive biases can be associated with psychopathology in chronic pain and in T2D, but can also potentially be adaptive in those with T2D. Diabetes management interventions may require a careful balance between promoting sufficient concern to motivate engagement in adaptive diabetes self-management, whilst also minimizing fear of hypoglycemia.

Selective attention to threat, anxiety and glycaemic management in adolescents with type 1 diabetes

Objective

Previous research has established that adolescents with type 1 diabetes (T1D) experience more anxiety symptoms than their healthy peers and are also more likely to develop an anxiety disorder. Research in cognitive psychology has found that selective attention favouring the processing of threatening information causally contributes to elevated levels of anxiety; however, this process has not been investigated in the context of T1D. The current study examined whether selective attention for threatening information contributes to the association between anxiety and glycaemic management in adolescents with T1D.

Methods

Participants completed a dot-probe task to assess selective attention for diabetes-related threatening information and general non-diabetes-related threatening information and we examined the associations between these measures and measures of HbA1c and anxiety.

Results

Findings suggest that individual differences in anxiety vulnerability do not predict HbA1c alongside the attentional bias for threatening information.

Conclusions

The attentional bias for threatening information makes a contribution to the relationship between anxiety and glycaemic management and may represent a target for therapeutic intervention to both reduce anxiety and improve glycaemic management

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Adolescents with T1D are at increased risk for experiencing anxiety.

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Elevated anxiety is associated with poorer glycaemic control.

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Selective attention to threatening information contributes to this relationship.

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Biased attentional processing for threat may represent a therapeutic target in T1D.