Psychosocial and quality of life correlates of glycemic control during intensive treatment of type 1 diabetes

To identify emotional and attitudinal barriers to improved glycemic control (HbA(1c)) during intensive diabetes treatment, 55 patients attending a 4-5 month intensive diabetes medical/education clinic were followed. Subjects completed a battery of psychological surveys, had HbA(1c) and body mass ind ex measured, and rated their attitude toward weight gain and the extent of problems with specific self-management behaviors before and after the medic al intervention. Although HbA(1c) improved on average, 29% had only modest improvement and 16% showed no improvement. The number of diabetes-related a nnoyances, worry about hypoglycemia, and diabetes-related emotional distres s diminished. Only the satisfaction subscale of the Diabetes Quality of Lif e survey, diabetes-related emotional distress, and problems with self-manag ement behaviors correlated with HbA(1c). Treatment-related frustration and emotional distress may initially act as motivators to improve glycemia but can later become barriers to that goal. Interventions designed to help pati ents overcome attitudinal barriers should be incorporated into medical prog rams geared toward improving glycemia. (C) 2001 Elsevier Science Ireland Lt d. All rights reserved.