Psychological flexibility is associated with less diabetes distress and lower glycated haemoglobin in adults with type 1 diabetes

Abstract

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.

Brief online acceptance and commitment therapy for adults with type 1 diabetes: a pilot study

“…Psychological flexibility may be a significant factor to consider when selecting and customizing intervention options for diabetes self-management, acceptance, and coping patterns. For example, if psychological inflexibility is related to the level of diabetes distress and how patients deal with their diabetes self-management tasks, a multidisciplinary team can address inflexibility and/or consider how to reduce the burden of the diabetes regimen ( 25 ).…”

Impact of an Acceptance and Commitment Therapy programme on HbA1c, self-management and psychosocial factors in adults with type 1 diabetes and elevated HbA1c levels: a randomised controlled trial

“…With its focus on acceptance of discomfort, ACT has also been argued to be especially suitable for long-term conditions where distress can be a realistic factor 31. 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. A meta-analysis concluded that ACT interventions may improve the ability of self-care, psychological flexibility and HbA1c in type 2 diabetes 33.…”

“… 31 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 A meta-analysis concluded that ACT interventions may improve the ability of self-care, psychological flexibility and HbA1c in type 2 diabetes. 33 Within the scope of type 1 diabetes, few ACT interventions for adults have been evaluated.…”

An online acceptance, commitment, and self-compassion based treatment to decrease psychological distress in people with type 2 diabetes: A feasibility randomised-controlled trial

“…Psychological flexibility is the key process targeted within Acceptance Commitment Therapy (ACT) ( Hayes et al, 2011 ) and there is growing evidence that ACT is useful for people with long-term conditions ( Graham et al, 2016 ), which may also increase self-compassion. 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 ). Thus, treatments that specifically aim to increase self-compassion and psychological flexibility may improve psychological outcomes in people with T2D.…”