title: Association of HbA1c with emotion regulation, intolerance of uncertainty, and purpose in life in type 2 diabetes mellitus.
abstract: BACKGROUND
  The extant literature lacks breadth on psychological variables associated with health outcome for type 2 diabetes mellitus (T2DM). This investigation extends the scope of psychological information by reporting on previously unpublished factors.
  
  
  OBJECTIVE
  To investigate if intolerance of uncertainty, emotion regulation, or purpose in life differentiate T2DM adults with sustained high HbA(1c) (HH) vs. sustained acceptable HbA(1c) (AH).
  
  
  METHODS
  Cross-sectional observational study. Adult patients with diagnosed T2DM meeting inclusionary criteria for AH, HH, or a nondiabetic reference group (NDR) were randomly selected and invited to participate. Patients who consented and participated resulted in a final sample of 312 subgrouped as follows: HH (n = 108); AH (n = 98); and NDR (n = 106). Data sources included a survey, self-report questionnaires, and electronic medical record (EMR).
  
  
  RESULTS
  HH individuals with T2DM reported lower purpose in life satisfaction (p = 0.005) compared to the NDR group. The effect size for this finding is in the small-to-medium range using Cohen's guidelines for estimating clinical relevance. The HH-AH comparison on purpose in life was nonsignificant. The emotion regulation and intolerance of uncertainty comparisons across the three groups were not significant.
  
  
  CONCLUSIONS
  The present study determined that lower purpose in life satisfaction is associated with higher HbA(1c). In a T2DM patient with sustained high HbA(1c), the primary care clinician is encouraged to consider screening for purpose in life satisfaction by asking a single question such as "Do the things you do in your life seem important and worthwhile?" The patient's response will assist the clinician in determining if meaning or purpose in life distress may be interferring with diabetes self-care. If this is the case, the clinician can shift the conversation to the value of behavioral and emotional health counseling.
authors.affiliation: Department of Psychiatry and Psychology, Division of Integrated Behavioral Healthcare, Mayo Clinic, Rochester, MN, USA; Department of Family Medicine, Mayo Clinic, Rochester, MN, USA. Electronic address: rasmussen.norman@mayo.edu.
authors.forename: Norman H
authors.initials: NH
authors.lastname: Rasmussen
authors.forename: Steven A
authors.initials: SA
authors.lastname: Smith
authors.forename: Julie A
authors.initials: JA
authors.lastname: Maxson
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Bernard
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Cha
authors.forename: David C
authors.initials: DC
authors.lastname: Agerter
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis / Q000523:psychology*; D057286:Electronic Health Records; D004644:Emotions; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010549:Personal Satisfaction; D011320:Primary Health Care; D011788:Quality of Life; D057566:Self Report; D035501:Uncertainty
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: AH; CCI; Charlson comorbidity index; DERS; Emotion regulation; HH; HbA(1c); ICD-9; IUS-12; International Classification of Diseases, ninth edition; Intolerance of uncertainty; LET; NDR; PHQ-9; Primary care; Purpose in life satisfaction; T2DMM; acceptable A1c; difficulties in emotion regulation scale; high A(1c); intolerance of uncertainty scale, short form; life engagement test; nondiabetic reference group; patient health questionnaire–depression scale; type 2 diabetes mellitus