Depression, Obesity and Smoking were Independently Associated with Inadequate Glycemic Control in Patients with Type 1 Diabetes.

OBJECTIVE: The aim of this study was to explore the associations between inadequate glycemic control of diabetes and psychological, anthropometric and life style variables in a population based cohort of type 1 diabetes patients. DESIGN: Cross-sectional study. METHODS: In this study 292 patients with type 1 diabetes participated, age 18-59 years. Psychological data were assessed by self-report instruments, Hospital Anxiety and Depression Scale and Toronto Alexithymia Scale-20. Anthropometrics, blood analyses, data from medical records and data from the Swedish National Diabetes Registry were collected. RESULTS: Self-reported depression (Adjusted Odds Ratio (AOR) 4.8), obesity (AOR 4.3) and smoking (AOR 3.0) were independently associated with inadequate glycemic control of diabetes (HbA1c >8.6%). Gender stratified analyses showed that self-reported depression (AOR 19.8) and obesity (AOR 7.0) in women; and smoking in men (AOR 4.2) were associated with HbA1c >8.6%. Alexithymia, antidepressant medication and physical inactivity were associated with HbA1c >8.6% only in bivariate analyses. Alexithymia, self-rated anxiety, physical inactivity and absence of abdominal obesity were associated with self-reported depression. CONCLUSIONS: Depression was the only psychological factor independently associated with HbA1c >8.6%. The association was of comparable importance as obesity and smoking, well known risk factors for inadequate glycemic control and diabetes complications. The association between depression and HbA1c >8.6% was particularly strong for women. Alexithymia, which is a relatively stable personality trait, was associated with depression. In the future care of patients with diabetes, psychological aspects should be considered alongside anthropometrics and life style factors in order to achieve the goals for HbA1c.