title: Relationships of diabetes-specific emotional distress, depression, anxiety, and overall well-being with HbA1c in adult persons with type 1 diabetes.
abstract: OBJECTIVE
  Emotional problems are common in adults with diabetes, and knowledge about how different indicators of emotional problems are related with glycemic control is required. The aim was to examine the relationships of diabetes-specific emotional distress, depression, anxiety, and overall well-being with glycosylated hemoglobin (HbA1c).
  
  
  METHODS
  Of the 319 adults with type 1 diabetes attending the endocrinology outpatient clinic at a university hospital in Norway, 235 (74%) completed the Diabetes Distress Scale, the Problem Areas in Diabetes Survey, the Hospital Anxiety and Depression Scale, and the World Health Organization-Five Well-Being Index. Blood samples were taken at the time of data collection to determine HbA1c. Regression analyses examined associations of diabetes-specific emotional distress, anxiety, depression, and overall well-being with HbA1c. The relationship between diabetes-specific emotional distress and HbA1c was tested for nonlinearity.
  
  
  RESULTS
  Diabetes-specific emotional distress was related to glycemic control (DDS total: unstandardized coefficient=0.038, P<.001; PAID total: coefficient=0.021, P=.007), but depression, anxiety, and overall well-being were not. On the DDS, only regimen-related distress was independently related to HbA1c (coefficient=0.056, P<.001). A difference of 0.5 standard deviation of baseline regimen distress is associated with a difference of 0.6 in HbA1c. No significant nonlinearity was detected in the relationship between diabetes-specific distress and HbA1c.
  
  
  CONCLUSIONS
  To stimulate adequate care strategies, health personnel should acknowledge depression and diabetes-specific emotional distress as different conditions in clinical consultations. Addressing diabetes-specific emotional distress, in particular regimen distress, in clinical consultation might improve glycemic control.
authors.affiliation: Centre for Evidence Based Practice, Bergen University College, Norway; Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Norway. Electronic address: rob@hib.no.
authors.forename: Ragnhild Bjarkøy
authors.initials: RB
authors.lastname: Strandberg
authors.affiliation: Centre for Evidence Based Practice, Bergen University College, Norway; Department of Paediatrics, Haukeland University Hospital, Bergen, Norway.
authors.forename: Marit
authors.initials: M
authors.lastname: Graue
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway; Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Norway; Centre for Clinical Research, Haukeland University Hospital, Norway.
authors.forename: Tore
authors.initials: T
authors.lastname: Wentzel-Larsen
authors.affiliation: Department of Sociology, Loyola University MD, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Peyrot
authors.affiliation: Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Norway; Department for Research and Development, Haukeland University Hospital, Norway.
authors.forename: Berit
authors.initials: B
authors.lastname: Rokne
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D010045:Outpatients / Q000706:statistics & numerical data; D010549:Personal Satisfaction; D011788:Quality of Life; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Anxiety; Depression; Diabetes-specific emotional distress; HbA(1c); Type 1 diabetes