title: Depression, obesity, and smoking were independently associated with inadequate glycemic control in patients with type 1 diabetes.
abstract: OBJECTIVE
  The aim of this study was to explore the associations between inadequate glycemic control of diabetes and psychological, anthropometric, and lifestyle variables in a population-based cohort of type 1 diabetes patients.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  In this study, 292 patients with type 1 diabetes, aged 1859 years, participated. psychological data were assessed by self-report instruments: Hospital Anxiety and Depression Scale and Toronto Alexithymia Scale-20. Anthropometrics, blood analyses, data from medical records, and data from the Swedish National Diabetes Registry were collected.
  
  
  RESULTS
  Self-reported depression (adjusted odds ratio (AOR) 4.8), obesity (AOR 4.3), and smoking (AOR 3.0) were independently associated with inadequate glycemic control of diabetes (HbA1c>8.6%). Gender-stratified analyses showed that self-reported depression (AOR 19.8) and obesity (AOR 7.0) in women and smoking in men (AOR 4.2) were associated with HbA1c>8.6%. Alexithymia, antidepressant medication, and physical inactivity were associated with HbA1c>8.6% only in bivariate analyses. Alexithymia, self-rated anxiety, physical inactivity, and absence of abdominal obesity were associated with self-reported depression.
  
  
  CONCLUSIONS
  Depression was the only psychological factor independently associated with HbA1c>8.6%. The association was of comparable importance as obesity and smoking, well-known risk factors for inadequate glycemic control and diabetes complications. The association between depression and HbA1c>8.6% was particularly strong for women. Alexithymia, which is a relatively stable personality trait, was associated with depression. In the future care of patients with diabetes, psychological aspects should be considered alongside anthropometrics and lifestyle factors in order to achieve the goals for HbA1c.
authors.affiliation: Primary Care, Kronoberg County Council, Växjö, Sweden. eva.melin@ltkronoberg.se
authors.forename: Eva O
authors.initials: EO
authors.lastname: Melin
authors.forename: Maria
authors.initials: M
authors.lastname: Thunander
authors.forename: Ralph
authors.initials: R
authors.lastname: Svensson
authors.forename: Mona
authors.initials: M
authors.lastname: Landin-Olsson
authors.forename: Hans O
authors.initials: HO
authors.lastname: Thulesius
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D003430:Cross-Sectional Studies; D003863:Depression / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood*; D012907:Smoking / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D001786:Blood Glucose