The cross-sectional associations between sense of coherence and diabetic microvascular complications, glycaemic control, and patients' conceptions of type 1 diabetes.
BACKGROUND
Sense of coherence (SOC) has been associated with various self-care behaviours in the general population. As the management of type 1 diabetes heavily relies on self-management, the SOC concept could also prove important in this population. This paper is a report of a study conducted among patients with type 1 diabetes to assess the associations between SOC and glycaemic control, microvascular complications, and patients' conceptions of their disease.


METHODS
Altogether 1,264 adult patients (45% men, age range 18-82 years) with type 1 diabetes participated in this cross-sectional study. SOC was evaluated using a 13-item SOC questionnaire. Standardized assays were used to determine HbA1c. Nephropathy status was based on albumin excretion rate and retinal laser-treatment was used as an indication of severe retinopathy. Patients' subjective conceptions of diabetes were studied using a questionnaire.


RESULTS
Higher SOC scores, reflecting stronger SOC, were associated with lower HbA1c values. Strong SOC was independently associated with reaching the HbA1c level <7.5%. Adjusting for diabetes duration, age at onset, socioeconomic status and HbA1c, weak SOC was associated with the presence of nephropathy among men, but not women. No associations were observed between SOC and severe retinopathy. Four dimensions describing patients' conceptions of HbA1c, complications, diabetes control and hypoglycaemia were formed from the diabetes questionnaire. Weak SOC was independently associated with worse subjective conceptions in the dimensions of HbA1c and hypoglycaemia. Furthermore among men, an association between weak SOC and the complications factor was observed.


CONCLUSIONS
Interventions to improve patients' SOC, if available, could improve patients' metabolic control and therefore also reduce the incidence of diabetic complications.
Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Finland. per-henrik.groop@helsinki.fi
Aila J
AJ
Ahola
Markku
M
Saraheimo
Carol
C
Forsblom
Kustaa
K
Hietala
Per-Henrik
PH
Groop
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology* / Q000628:therapy; D003925:Diabetic Angiopathies / Q000097:blood / Q000150:complications / Q000517:prevention & control*; D003928:Diabetic Nephropathies / Q000175:diagnosis; D005260:Female; D005387:Finland; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000517:prevention & control; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D060685:Sense of Coherence; D012737:Sex Factors; D011795:Surveys and Questionnaires
D006442:Glycated Hemoglobin