The Influence of Diabetes-Related Worry and Worry-Driven Behaviour on the Self-Management of Type 1 Diabetes Mellitus
Coons, Michael James
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Background. Type 1 diabetes mellitus (T1DM) requires the ongoing self-management of blood glucose to minimize the likelihood of serious morbidity and premature mortality. Adherence to clinical recommendations is challenging and is influenced by serious short-term complications of self-management (e.g., hypoglycemia, hyperglycemia) and long-term vascular pathology (e.g., eye disease, heart attack). Worry of hypoglycemia (WoH) and worry of vascular complications (WVC) are two cognitive and behavioural constructs that have important implications for blood glucose control. Although researchers have argued that avoidance behaviour explains the relationship between diabetes-related worry and blood glucose, data supporting this assertion is lacking. Furthermore, the impact of diabetes-related worry and worry-driven behaviour on important health-related quality of life (HRQoL) dimensions is unclear. The purpose of the present study was to provide the first test of this avoidance behaviour mediation hypothesis, and to examine the relationships between diabetes-related worry, avoidance behaviour and HRQoL (perceived impact; self-management satisfaction). Method. One hundred and fifty two individuals with T1DM completed a self-report questionnaire package, and 129 participants had blood glucose values (i.e., A1C) available for analysis. Results. Avoidance behaviour did not mediate the relationships between diabetes-related worry and blood glucose. However, WoH was associated with avoidance behaviour, which in turn, was associated with higher blood glucose levels. Hypoglycemia avoidance behaviour mediated the positive relationship between WoH and the perceived impact of having diabetes, and WVC and hyperglycemia avoidance behaviour were independently associated with the perceived impact of having diabetes. While WoH and WVC were associated with lower satisfaction with self-management practices, hypoglycemia subtle avoidance behaviour, hyperglycemia avoidance behaviour, and complication vigilance/risk behaviour avoidance was associated with greater satisfaction. Discussion. In the majority of cases, the avoidance behaviour mediation hypotheses were not supported by these data. However, these results highlight the differential impact of diabetes-related worry and worry-driven behaviour on blood glucose and HRQoL among individuals with T1DM. Strengths and limitations of the present study are discussed, and directions for future research are offered.