PHOBIC SYMPTOMS, PARTICULARLY THE FEAR OF BLOOD AND INJURY, ARE ASSOCIATED WITH POOR GLYCEMIC CONTROL IN TYPE-I DIABETIC ADULTS

OBJECTIVE - To investigate the presence of psychiatric disorders and s ymptoms in type I diabetic patients and to identify those that may inf luence metabolic control as assessed by GHb levels. RESEARCH DESIGN AN D METHODS - This was a cross-sectional study. One hundred and two cons ecutive patients with type I diabetes who were regular outpatient visi tors of a diabetology department were evaluated. The psychiatric asses sments included self-rating questionnaires (General Health Questionnai re and Fear Questionnaire) and observer-rating questionnaires (Montgom ery-Asberg Depression Rating Scale [MADRS] and Mini International Inte rview). Diabetic characteristics were assessed by a structured intervi ew The observer was blind to the diabetic characteristics of the patie nts. RESULTS - Type I diabetic patients with GHb levels greater than o r equal to 8% had higher psychological distress, scored significantly higher for symptoms of agoraphobia and for fear of blood and injury, h ad substantially higher levels of anxiety-depression, and performed si gnificantly fewer blood glucose measurements per day. They did not dif fer in MADRS score from patients with GHb levels <8%. Multivariate ana lysis showed that GHb was positively associated with the total score o f phobic symptoms and the level of anxiety-depression and inversely as sociated with the number of daily blood glucose measurements. These fa ctors explained 41% of the variance of GHb. The inverse relationship b etween GHb and the number of blood glucose measurements per day was ma inly influenced by the fear of blood and injury Patients with high sco res for the fear of blood and injury performed fewer blood glucose mea surements and had poorer glycemic control; conversely, subjects withou t fear of blood and injury performed more daily blood glucose measurem ents and had better glycemic control. CONCLUSIONS - Phobic symptoms ar e frequent in patients with type I diabetes. The intensity of phobic s ymptoms and anxiety-depression negatively influences metabolic control , Increased fear of blood and injury may lead some patients to perform few home blood glucose measurements and may result in poorer glycemic control. This suggests that, by decreasing the fear of blood, injury, and injection, metabolic control may be improved.