Article

Positive Psychological Characteristics in Diabetes: A Review.

Harvard Medical School, Boston, MA, USA, .
Current Diabetes Reports (Impact Factor: 3.38). 09/2013; 13(6). DOI: 10.1007/s11892-013-0430-8
Source: PubMed

ABSTRACT Positive psychological characteristics, such as optimism, self-efficacy, and resilience, have been increasingly associated with improved outcomes in medically ill individuals. However, there has been minimal systematic review of these characteristics and their associations with outcomes in people with diabetes. We aim to review these associations, their potential mediating mechanisms, and the evidence supporting interventions targeting these qualities. In people with diabetes, positive psychological characteristics are significantly associated with improved glycemic control, fewer complications, and reduced rates of mortality. Potential mechanisms mediating these associations include behavioral factors (e.g., improved treatment adherence), reduced inflammation, and improved neuroendocrine and autonomic functioning. Most psychosocial treatments in this population have focused on improving self-efficacy and resilience; such interventions may improve quality of life, well-being, and diabetes self-care. While untested in diabetes, interventions to boost other positive characteristics have been effective in other medically ill patients and may warrant further study in this cohort.

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    ABSTRACT: Psychological insulin resistance (PIR) affects patients' self-care behaviors and quality of life due to the delay of insulin treatment for optimal glycemic control. Although effective patient-provider communication and relationships have been shown to improve patients' overall treatment adherence and attitude toward treatment, little is known about the potential mechanisms by which effective patient-provider communication and relationships decrease PIR and whether these relationships are mediated by diabetes self-efficacy. The purpose of this study is to examine whether diabetes self-efficacy among patients with type 2 diabetes (T2D) mediates the relationships between PIR and perceived patient-provider relationships. A total of 178 patients with T2D participated in a cross-sectional study. Data were obtained by patient interview using validated measures of diabetes attitude, diabetes knowledge, self-efficacy, and patient-provider communication. PIR was measured by using a validated measure, Barriers to Insulin Treatment. A structural equation model was developed to estimate direct and indirect effects of patient-provider relationship on PIR when self-efficacy was controlled as a mediator. Diabetes knowledge and attitude were not significantly associated with PIR. Better patient-provider relationship was directly associated with lower PIR (β = -.40, p = 0.008). When diabetes self-efficacy was included as a mediator, the direct effect between patient-provider relationship and PIR changed (β = -.27, p = 0.034), indicating that better patient-provider relationship that reduces PIR is due to greater diabetes self-efficacy. The findings suggest that development of intervention programs aimed at improving diabetes self-efficacy-which may be positively correlated with better patient-provider relationship-is needed to reduce PIR.