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Determinants of psychological well-being in insulin treated persons with diabetes

Psychological well-being is an important, patient-centered endpoint of diabetes care. This study was aimed at examining psychological well-being in insulin-treated patients and determining its associations with disease-related variables and coping with diabetes as assessed by diabetes care providers. Psychological well-being was assessed by using the WHO-5 Well-being index in 828 insulin-treated patients (49% female, aged 59&#177; 13 yrs, 13% with type 1 diabetes, diabetes duration 11&#177; 8 yrs, HbA1C 8.8%&#177; 1.8, BMI 27 kg/m2&#177; 4, with neuropathy in 53%, nephropathy in 13% and retinopathy in 38% cases). Their diabetes care providers were instructed to classify the patients' coping with diabetes, taking account of the prevailing emotions (positive vs negative), and approach towards information (active vs passive). Five different patterns were described as &#171; Empowered and in control&#187; (positive ; active) , &#171; Fearful information seeker&#187; (negative ; active), &#171; Tell me what to do&#187; (neutral ; passive) &#171; Resentful victim&#187; (negative ; passive) or &#171; Feeling fine and do not care&#187; (positive ; passive). Analysis of variance and multiple regression analysis were used to define demographic, disease-related and coping-related factors affecting psychological well-being. Results: The well-being scores in the examined subjects differed with respect to gender (male vs female 14&#177; 6 vs 13&#177; 6 ; p=0.01), type of diabetes (type 1 vs type 2 15&#177; 7 vs 13&#177; 6 ; p=0.0001), presence of neuropathy (yes vs no 11&#177; 5 vs 15&#177; 6 ; p=0.0000), presence of retinopathy (yes vs no 11&#177; 5 vs14&#177; 5 ; p=0.0000), experienced family support (yes vs no14&#177; 6 vs 12&#177; 6 ; p=0.0002), and coping as assessed by diabetes care providers. &#171; Empowered and in control&#187; subjects obtained the highest well-being scores (15&#177; 6) followed by &#171; Tell me what to do&#187; (13&#177; 6), &#171; Fearful information seeker&#187; (12&#177; 5), &#171; Feeling fine and do not care&#187; (11&#177; 5) and &#171; Resentful victim&#187; (9&#177; 5) groups. The empowered group scored better than all other groups (all p<0.01), while the &#171; Fearful information seeker&#187; and &#171; Tell me what to do&#187; groups scored better than &#171; Resentful victim&#187; group (p=0.00001 and p=0.0.0000, respectively). The subjects described as &#171; Feeling fine and do not care&#187; scored their well-being to be low. Seventy-one percent of patients from this group obtained WHO-5 scores <13, indicating possibly serious emotional problems (compared to 25% of subjects with scores <13 in the empowered group, 36% in the fearful group, 49% in the group relying on their physicians, and 74% in the &#171; Resentful victim&#187; group). Multiple regression analysis indicated that psychological well-being could be predicted by gender, age, type and duration of diabetes, neuropathy, retinopathy, HbA1C, family support, and coping-related characteristics as assessed by health care providers (R2=0.195 F=13.93 ; p=0.0001). Being younger, free of complications, supported by family, with better glycaemic control, and approaching diabetes positively/actively independently predicted better psychological well-being. Psychological well-being was found to be associated with age, gender, experienced family support, glycaemic control, diabetes complications and coping with the disease. The self-assessed well-being seemed to be interrelated with the providers' assessments. However, poor well-being remained unrecognized in patients labeled as &#171; Feeling fine and do not care&#187; . Self-assessments of psychological well-being should be incorporated into routine diabetes care.

psychological well-being; diabetes mellitus; coping with diabetes

42nd EASD Annual Meeting of the European Association for the Study of Diabetes, Copenhagen, Denmark, 14 &#8211 ; 17 September 2006 ; P 0864