Depression, obesity, and smoking were independently associated with inadequate glycemic control in patients with type 1 diabetes

Abstract

Objective: The aim of this study was to explore the associations between inadequate glycemic control of diabetes and psychological, anthropometric, and lifestyle variables in a population-based cohort of type 1 diabetes patients. Design: Cross-sectional study. Methods: In this study, 292 patients with type 1 diabetes, aged 18-59 years, participated. Psychological data were assessed by self-report instruments: Hospital Anxiety and Depression Scale and Toronto Alexithymia Scale-20. Anthropometrics, blood analyses, data from medical records, and data from the Swedish National Diabetes Registry were collected. Results: Self-reported depression (adjusted odds ratio (AOR) 4.8), obesity (AOR 4.3), and smoking (AOR 3.0) were independently associated with inadequate glycemic control of diabetes (HbA1cO8.6%). Gender-stratified analyses showed that self-reported depression (AOR 19.8) and obesity (AOR 7.0) in women and smoking in men (AOR 4.2) were associated with HbA1cO8.6%. Alexithymia, antidepressant medication, and physical inactivity were associated with HbA1cO8.6% only in bivariate analyses. Alexithymia, self-rated anxiety, physical inactivity, and absence of abdominal obesity were associated with self-reported depression. Conclusions: Depression was the only psychological factor independently associated with HbA1cO 8.6%. The association was of comparable importance as obesity and smoking, well-known risk factors for inadequate glycemic control and diabetes complications. The association between depression and HbA1cO8.6% was particularly strong for women. Alexithymia, which is a relatively stable personality trait, was associated with depression. In the future care of patients with diabetes, psychological aspects should be considered alongside anthropometrics and lifestyle factors in order to achieve the goals for HbA1c.

Association of diet and lifestyle with glycated haemoglobin in type 1 diabetes participants in the EURODIAB prospective complications study

“…Several cross-sectional studies, and a prospective study in over 700 T1DM patients followed for 16 years, showed that smoking was associated with poor glycemic control. 15,20 We also found initially an association with poor glycemic control in current smokers, as was shown previously in EURODIAB cross-sectionally. 16 Further adjustments for dietary components, however, attenuated these results.…”

“…This is consistent with previous research. 13,15 Lifestyle variables PA, and alcohol intake were not significantly associated with HbA1c in this study. Results indicated a tendency towards improved glycemic control with higher levels of PA which is what we expected.…”

“…14 Another prospective study demonstrated that more strenuous exercise or activity level at work was associated with worse glycemia in T1DM. 13 There is evidence from cross-sectional studies [15][16][17][18][19] and a more recent prospective study that current smoking is associated with poor glycemic control. 20 For alcohol, one large prospective study in 438 000 diabetes patients demonstrated that 2-3 drinks of alcohol per day is associated with better glycemic control, but this study did not distinguish between type 1 and type 2 diabetes patients.…”

The Effect of Cigarette Smoking on Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis

“…A previous meta-analysis showed a 44 % increased risk of developing type 2 diabetes for smokers compared with nonsmokers 52 . Among persons with diabetes, prior studies have suggested that smoking is also associated with insulin resistance 53 and higher insulin needs 54 55 , and thus poor metabolic control [56][57][58][59][60][61] . As microvascular complications in individuals with type 1 or type 2 diabetes are highly linked to metabolic control 62 63 , A1C probably acts as a mediator in the relationship between smoking and DPN.…”

Gender, alexithymia and physical inactivity associated with abdominal obesity in type 1 diabetes mellitus: a cross sectional study at a secondary care hospital diabetes clinic

“…Depression in diabetes have been linked to life style factors such as less physical activity and unhealthy diet [23]. We have previously shown that self-reported depression in this population was associated with impaired glycemic control [3] and increased midnight cortisol secretion [24]. Even if there is evidence for a positive association between obesity and anxiety disorders [25, 26], the strength of the association is depending on anxiety subtype [26].…”