Delay discounting of gains and losses, glycemic control and therapeutic adherence in type 2 diabetes.
OBJECTIVE
Delay discounting is the tendency to prefer smaller, sooner rewards to larger, later ones. Poor adherence in type 2 diabetes could be partially explained by a discounted value of health, as a function of delay. Delay discounting can be described with a hyperbolic model characterized by a coefficient, k. The higher k, the less future consequences are taken into account when making decisions. This study aimed to determine whether k would be correlated with glycated hemoglobin and adherence in type 2 diabetes.


METHODS
Ninety-three patients were recruited in two diabetology departments. Delay discounting coefficients were measured with a computerized task. HbA1c was recorded and adherence was assessed by questionnaires. Potential socio-demographic and clinical confounding factors were collected.


RESULTS
There was a positive correlation between delay discounting of gains and HbA1c (r=0.242, P=0.023). This association remained significant after adjusting for potential confounding factors (F=4.807, P=0.031, η2=0.058). This association was partially mediated by adherence to medication (β=0.048, 95% CI [0.004-0.131]).


CONCLUSIONS
Glycemic control is associated with delay discounting in patients suffering from type 2 diabetes. Should these findings be replicated with a prospective design, they could lead to new strategies to improve glycemic control among these patients.
Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France; Inserm U894, Center for Psychiatry and Neuroscience, Paris, France; AP-HP, West Paris University Hospitals, Department of Psychiatry, Paris, France. Electronic address: gaele.lebeau@gmail.com.
Gaële
G
Lebeau
Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France; AP-HP, West Paris University Hospitals, Department of Psychiatry, Paris, France.
Silla M
SM
Consoli
Inserm U1127, CNRS U7225, Brain and Spine Institute, "Motivation, Brain and Behavior" Team, Pitié-Salpêtrière Hospital, Paris, France; Pierre and Marie Curie University, Paris, France; AP-HP, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France.
Raphael
R
Le Bouc
AP-HP, Diabetology Department, Cochin Hospital, Paris, France.
Agnès
A
Sola-Gazagnes
Pierre and Marie Curie University, Paris, France; AP-HP, Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France.
Agnès
A
Hartemann
Pierre and Marie Curie University, Paris, France; AP-HP, Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Pitié Salpêtrière Hospital, Paris, France.
Dominique
D
Simon
AP-HP, Endocrinology, Diabetology and Metabolic Diseases Department, Avicenne Hospital, Bobigny, France; Paris 13 University, Sorbonne Paris Cité, Bobigny, France.
Gerard
G
Reach
Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France; AP-HP, West Paris University Hospitals, Diabetology Department, Paris, France.
Jean-Jacques
JJ
Altman
Inserm U1127, CNRS U7225, Brain and Spine Institute, "Motivation, Brain and Behavior" Team, Pitié-Salpêtrière Hospital, Paris, France; Pierre and Marie Curie University, Paris, France.
Mathias
M
Pessiglione
Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France; Inserm U894, Center for Psychiatry and Neuroscience, Paris, France; AP-HP, West Paris University Hospitals, Department of Psychiatry, Paris, France.
Frédéric
F
Limosin
Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France; Inserm U894, Center for Psychiatry and Neuroscience, Paris, France; AP-HP, West Paris University Hospitals, Department of Psychiatry, Paris, France.
Cédric
C
Lemogne
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D065786:Delay Discounting; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
Adherence; Delay discounting; Diabetes mellitus type 2; Glycated hemoglobin