Symptoms and Well-Being in Relation to Glycemic Control in Type II Diabetes
Open accessAbstract
OBJECTIVE: To describe the cross-sectional relation between glycemic control and physical symptoms, emotional well-being, and general well-being in patients with type II diabetes. RESEARCH DESIGN AND METHODS: The study population consisted of 188 patients with type II diabetes between 40 and 75 years of age. Patients were treated with blood glucose-lowering agents or had either a fasting venous plasma glucose level ≥7.8 mmol/l or an HbA1c level > 6.1%. Multiple regression analyses were performed. Dependent variables were scores on the Type II Diabetes Symptom Checklist, the Profile of Mood States, the Affect Balance Scale, and questions regarding general well-being. The primary determinant under study was HbA1c. In addition, age, sex, neuroticism (indicating a general tendency to complain), insulin use, and comorbidity were included as determinants in all analyses. Other potential determinants taken into consideration were hypoglycemic complaints, marital status, diabetes duration, cardiovascular history, blood pressure, BMI, waist-to-hip ratio, perceived burden of treatment, and smoking. None of these potential determinants had to be included to correct confounding of the relation between HbA1c and well-being scores. RESULTS: Higher HbA1c levels were significantly associated with higher symptom scores (total score, hyperglycemic score, and neuropathic score), with worse mood (total score, displeasure score, depression, tension, fatigue), and with worse general well-being. The relative risks varied between 1.02 and 1.36 for each percentage difference in HbA1c. The relation between HbA1c and some mood states was modified by neuroticism: in the less neurotic patient (i.e., one who is less inclined to complain), the relation was more evident. CONCLUSIONS: These data suggest that better glycemic control in type II diabetes is associated with fewer physical symptoms, better mood, and better well-being, in a nonhypoglycemic HbA1c range.
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Positive psychological states such as positive affect or optimism are prospectively and independently linked to improvements in health behaviors.
“these constructs have been prospectively and independently linked to improvements in health behaviors.”
From Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development (2015) · cites this paper as [28]
In type 2 diabetes, positive psychological states are prospectively associated with lower HbA1c, fewer diabetes complications, and lower rates of cardiac events/mortality.
“In T2D, positive psychological states (e.g., positive affect, well-being) are prospectively associated with lower HbA1c, fewer diabetes complications, and lower rates of cardiac events/mortality [26–28]”
From Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development (2015) · cites this paper as [28]
The effects of positive states on health behaviors and outcomes in medical illnesses persist even after accounting for negative affect/depression.
“Furthermore, the effects of positive states on health behaviors and outcomes in medical illnesses persist even after accounting for negative affect/depression [25, 28, 29, 36].”
From Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development (2015) · cites this paper as [28]
PP specifically targets behaviors (e.g., leveraging past success) and positive attributes (e.g., positive affect and optimism) that have been associated with increased participation in health behaviors and superior medical outcomes.
“Finally, as opposed to a focus on mindfulness, PP specifically targets behaviors (e.g., leveraging past success) and positive attributes (e.g., positive affect and optimism) that have been associated with increased participation in health behaviors and superior medical outcomes [26, 28, 29].”
From Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development (2015) · cites this paper as [28]
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- Authors
- Van der Does, F. E. E., De Neeling, J. N. D., Snoek, F. J., Kostense, P. J., Grootenhuis, P. A., Bouter, L. M., & Heine, R. J.
- Affiliations
- Institute for Research in Extramural Medicine (EMGO Institute), Vrije Universiteit Amsterdam, The Netherlands
- Amsterdam Public Health (NL)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 1996-03-01
- Volume
- 19
- Issue
- 3
- Pages
- 204-210
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2164470316
- Cited by
- 262
- References
- 11
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 6 · 2022: 5 · 2021: 3 · 2020: 12 · 2019: 6 · 2018: 3 · 2017: 5 · 2016: 6 · 2015: 7 · 2014: 6 · 2013: 6 · 2012: 8
- FWCI
- 6.72
- Type
- journal article
- Language
- en
- Open access
- green
- research.vu.nl
- Licence
- other-oa
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Novo Nordisk
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 2 diabetes, glycemic control, HbA1c, diabetes symptoms, mood, well-being, neuroticism, depression, fatigue, hyperglycemia, diabetic neuropathy, insulin use, comorbidities
- MeSH terms
- Adult, Affect, Aged, Attitude to Health, Blood Glucose, Cross-Sectional Studies, Depression, Diabetes Mellitus, Type 2, Fatigue, Female, Health Status, Glycated Hemoglobin, Humans, Hyperglycemia, Male, Middle Aged, Neurotic Disorders, Regression Analysis, Sex Factors, Stress, Psychological
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