Psychological flexibility is associated with less diabetes distress and lower Glycated Haemoglobin in adults with type 1 diabetes
Open accessAbstract
BACKGROUND: Diabetes distress, self-efficacy and health literacy are associated with diabetes self-management and health outcomes. Measures of coping styles and their impact on diabetes self-management and diabetes-related distress might add value in identifying those at risk of poorer health outcomes. Current evidence of associations between psychological flexibility/inflexibility and diabetes-related health outcomes is limited. AIMS: To measure associations of psychological flexibility, self-efficacy and health literacy with diabetes distress and glycated haemoglobin (HbA1c) in adults with type 1 diabetes. METHODS: We surveyed 105 adults with type 1 diabetes attending a tertiary diabetes outpatient clinic (mean age 27 ± 7.1 years; 53% men; duration of diabetes 12.6 ± 8.5 years; HbA1c 72 ± 22 mmol/mol, 8.7 ± 2.0%; 34% using insulin pumps). We assessed psychological flexibility, self-efficacy, health literacy and diabetes distress. Regression models explored the relative contributions of different factors to diabetes distress and HbA1c. RESULTS: The majority of health literacy scores were in the low-risk range. Those with greater psychological flexibility had higher self-efficacy (r = 0.34; P < 0.01) and reported less diabetes distress (r = -0.54; P < 0.001). In multiple regression analyses, psychological flexibility and self-efficacy accounted for 36% of the variance in distress score (P < 0.001). Shorter duration of diabetes (P < 0.001) and greater psychological flexibility (P < 0.01) correlated with lower HbA1c. A 10-point (one standard deviation) higher psychological flexibility score corresponded to a 0.5% lower HbA1c. CONCLUSIONS: Greater psychological flexibility was associated with less diabetes distress and lower HbA1c. The psychological flexibility construct might inform alternative interventional approaches aiming to improve well-being and glycaemic control.
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A recent study found that greater psychological flexibility in adults with type 1 diabetes was associated with less distress and more beneficial HbA1c.
“Furthermore, a recent study found that greater psychological flexibility in adults with type 1 diabetes was associated with less distress and more beneficial HbA1c.32”
There is emerging evidence that psychological flexibility may benefit people with T2D and be more applicable for treating coexisting mental health problems where CBT may be limited.
“There is also emerging evidence that psychological flexibility may benefit people with T2D (Nicholas et al., 2021), and be more applicable for treating coexisting mental health problems, where CBT may be limited (Arch and Ayers, 2013).”
From An online acceptance, commitment, and self-compassion based treatment to decrease psychological distress in people with type 2 diabetes: A feasibility randomised-controlled trial (2023) · cites this paper as Nicholas et al., 2021
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- Authors
- Nicholas, J. A., Yeap, B. B., Cross, D., & Burkhardt, M. S.
- Affiliations
- The University of Western Australia (AU)
- The Kids Research Institute Australia (AU)
- Corresponding author
- Nicholas, Jennifer A.
- Venue
- Internal Medicine Journal
- Publisher
- Wiley
- Published
- 2022-05-31
- Volume
- 52
- Issue
- 6
- Pages
- 952-958
- ISSN
- 1444-0903 (ISSN-L)
- 1445-5994
- OpenAlex
- W3134214281
- Cited by
- 15
- References
- 30
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 4 · 2023: 3 · 2022: 1
- FWCI
- 1.49
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Internal Medicine Journal (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Keywords
- psychological flexibility, diabetes distress, type 1 diabetes, HbA1c, self-efficacy, health literacy, diabetes self-management, glycemic control, coping styles, diabetes duration
- MeSH terms
- Adult, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Male, Surveys and Questionnaires, Stress, Psychological, Self Efficacy, Young Adult, Health Literacy
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