Factors explaining variation in self-esteem among persons with type 1 diabetes and elevated HbA1c

Abstract

ObjectivesTo investigate associations between perceived autonomy support from health-care professionals, autonomy-driven motivation, diabetes self-perceived competence and self-esteem in adults (age 18–55 yrs) with suboptimally regulated type 1 diabetes mellitus (T1DM) with at least one HbA1c≥8.0% (≥64 mmol/mol) during the past year, and whether these factors could predict decrease in self-esteem over time.MethodsA cross-sectional population-based survey was performed, and 9 months follow-up data were collected. Data collection comprised clinical and socio-demographic variables, blood sampling (HbA1c) and self-report questionnaires; the Health Care Climate Questionnaire (HCCQ), Treatment Self-Regulation Questionnaire (TSRQ), the Perceived Competence in Diabetes Scale (PCDS), and the Rosenberg Self-esteem Scale (RSES). We fitted block-wise linear regression models to assess associations between RSES and variables of interest (HCCQ, TSRQ, PCDS, HbA1c, clinical and socio-demographic variables) and linear regression models to assess predictors of change over time.FindingsIn this study sample, aged 36.7 (±10.7) mean HbA1c 9.3% (±1.1), 31.5% had long-term complications and 42.7% had experienced severe hypoglycemia within the previous 12 months. In the final regression model the association between PCDS and RSES was strongly significant (B = 1.99, p<0.001) and the associations between HCCQ, TSRQ and RSES were reduced to non-significance. All predictor variables combined explained 42% of the variability of RSES (adjusted R2 = 0.423) with PCDS contributing 18% to explained variance (R-square change = 0.184, p<0.001). The strongest predictors of change in RSES over time were long-term complications (B = 2.76, p<0.001), specifically foot-related problems, and being female (B = -2.16, p = 0.002).ConclusionsPerceived autonomy support, autonomy-driven motivation and diabetes self-perceived competence play a significant role in explaining self-esteem among adults with suboptimally regulated T1DM. Healthcare professionals should acknowledge self-esteem as a valuable factor in understanding the multifaceted health choices people with T1DM make.Trial registrationClinical Trials.gov with identification number NCT 01317459.

Validation of the Korean Version of the Health Care Climate Questionnaire among Cancer Survivors

“…Our study further verified the construct validity of the HCCQ-K, establishing a close relationship with both theoretically and empirically relevant factors encompassing psychological well-being and self-management. Empirical studies grounded in SDT have shown that the fulfillment of an individual's autonomy is linked to increased intrinsic motivation, well-being, and personal growth [7][8][9][10][11]. Conversely, individuals may encounter adverse outcomes such as diminished motivation and psychological distress when their autonomy needs are frustrated or unmet [7,8].…”

“…Grounded in the Self-Determination Theory (SDT), autonomy, which has been deemed a basic psychological need, is pivotal for fostering motivation, behavioral changes, and accomplishments [5][6][7]. In healthcare settings, patient autonomy signifies a sense of self-determined behavior, distinct from external pressures or control exerted by healthcare professionals [7][8][9][10][11].…”

Vision-related quality of life and locus of control in type 1 diabetes: a multicenter observational study

“…That women experience more profound discomfort in the presence of a complication had already been reported (28). In this sense, psychological support is important to help people with type 1 diabetes overcome the stigma of chronicity, as disease management may be hampered if a central self-concept of illness prevails.…”

“…In this sense, psychological support is important to help people with type 1 diabetes overcome the stigma of chronicity, as disease management may be hampered if a central self-concept of illness prevails. Improvement in treatment satisfaction and impact of disease support the efficacy of structured sustained educational processes, while increased self-esteem may be associated with strengthened problem-solving strategies (27,28). Both require patient-centered approaches.…”

Experiences of transition to adulthood and transfer to adult care in young adults with type 1 diabetes: A qualitative study

“…The ISPAD Clinical Practice Consensus Guidelines for psychological care of children, adolescents and young adults with diabetes highlights diabetes distress as an expected psychological response and an additional state (de Wit et al, 2022). HCPs ought to acknowledge mental health factors such as self-esteem when exploring the health choices of young adults with T1D (Mohn et al, 2018). Investigating indications of emotional distress, depression, anxiety, and cognitive capacity would help HCPs implement age-appropriate nursing care management (de Wit et al, 2022;Draznin et al, 2022).…”