title: Associations between patient characteristics, social relations, diabetes management, quality of life, glycaemic control and emotional burden in type 1 diabetes.
abstract: OBJECTIVE
  The objective was to investigate associations between emotional burden and a number of individual variables: patient characteristics, social relations, diabetes management in everyday life, generic quality of life and glycaemic control, including determining to what extend these variables explain the differences in emotional burden in a large Danish population of people with type 1 diabetes.
  
  
  METHODS
  We analysed a cross-sectional survey of 2419 Danish adults with type-1 diabetes mellitus and data from an electronic patient record. Data were analysed using hierarchical regression of factors of interest with emotional burden of diabetes as the dependent variable.
  
  
  RESULTS
  High emotional burden of diabetes was associated with being female, younger age, other chronic illness, low diabetes-specific support, low generic quality of life, low diabetes empowerment and high Hba1c. Low diabetes empowerment, low generic quality of life and low diabetes-specific support were associated with the largest difference in emotional burden level.
  
  
  CONCLUSIONS
  A variety of psychosocial and behavioural factors such as low social support, low generic quality of life and difficulties in managing diabetes are associated with high emotional burden in type-1 diabetes. These findings may call for an expansion of the effort to decrease the emotional burden of diabetes for those who are heavily burdened. Future research should explore the causality of the explored associations as well as potential subgroup differences in order to guide the development of appropriate interventions.
authors.affiliation: Steno Health Promotion Research, Steno Diabetes Center, Gentofte, Denmark. Electronic address: ljoe@steno.dk.
authors.forename: Lene E
authors.initials: LE
authors.lastname: Joensen
authors.affiliation: Gentofte University Hospital, Gentofte, Denmark.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Almdal
authors.affiliation: Steno Health Promotion Research, Steno Diabetes Center, Gentofte, Denmark.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Willaing
mesh_terms: D000223:Adaptation, Psychological; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D057286:Electronic Health Records; D004644:Emotions; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D010358:Patient Participation; D011788:Quality of Life; D012307:Risk Factors; D012648:Self Care; D012737:Sex Factors; D012919:Social Behavior; D012944:Social Support; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: Adults; Diabetes distress; Diabetes empowerment; Emotional burden; Generic quality of life; HbA1c; Self-management; Social support; Type-1 diabetes