Relationship and influences of behavioral and psychological factors on metabolic control of patients with type 2 diabetes mellitus

Vojislav Stanojević; Marija Jevtić; Milena  Mitrović; Marko Panajotović; Aleksandar Aleksić; Čedomirka Stanojević

doi:10.2298/VSP211011104S

Vojislav Stanojević Academy of Educational and Medical Professional Studies, Department in Ćuprija, Kruševac, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Marija Jevtić University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Milena Mitrović University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Marko Panajotović Military Medical Academy, Belgrade, Serbia
Aleksandar Aleksić Academy of Educational and Medical Professional Studies, Department in Ćuprija, Kruševac, Serbia
Čedomirka Stanojević Academy of Educational and Medical Professional Studies, Department in Ćuprija, Kruševac, Serbia

DOI: https://doi.org/10.2298/VSP211011104S

Keywords: depression;, diabetes mellitus, type 2;, obesity;, prognosis;, risk assessment;, psychology;, surveys and questionnaires;, therapeutics.

Abstract

Background/Aim. Achieving good metabolic control, which plays a key role in reducing or preventing macrovascular and microvascular complications of diabetes mellitus (DM), requires continuous patient involvement in the self-management of DM. This continued engagement, which makes type 2 DM (T2DM) one of the most physically and emotionally demanding diseases, can become, at certain periods of life, extremely severe and lead to emotional distress (symptoms of depression and DM-related distress) and deterioration of metabolic control. The aim of this study was to examine the association and influence of behavioral and psychological factors on the metabolic control of patients with T2DM. Methods. The research was conducted as a descriptive-analytic cross-sectional study. The method of random sampling included 324 subjects with T2DM in the research. The values of biochemical parameters of metabolic control were measured by standard laboratory methods. Blood pressure was measured two times, and the arithmetic mean was calculated. Anthropometric measurement was performed, and body mass index (BMI) was calculated. Attitudes toward medication adherence, adherence to dietary recommendations, level of physical activity, presence of depressive symptoms, and level of DM-related distress were examined using standardized questionnaires. Results. The target values of metabolic control parameters were reached by 21.6% of respondents. Multivariate analysis as predictors of poor metabolic control identified obesity, non-adherence toward dietary recommendations, insulin therapy, low level of physical activity, and clinically significant DM-related distress. Conclusion. Routine application of the questionnaire used in this study in the initial stages or critical moments of the disease can assess patients’ attitudes and knowledge about behavioral determinants of DM self-management and timely detect psychological conditions that affect them. It would be realistic to expect that such a comprehensive holistic approach would contribute to a lower incidence of complications and better metabolic control of T2DM.

References

1. Albuquerque C, Correia C, Ferreira M. Adherence to the therapeutic regime in person with type 2 diabetes. Procedia Soc Behav Sci 2015; 171: 350‒8.

2. Rakočević I, Miljuš D, Božić Z. Incidence and mortality of diabetes in Serbia, 2019. Belgrade: Institute of Public Health in Serbia „Dr. Milan Jovanović Batut“; 2020. http://www.
/>batut.org.rs/download/publikacije/dijabetes 2019.pdf. Accessed January 24, 2021.

3. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Atlas, 9th edition. Diabetes Res Clin Pract 2019; 157: 107843.

4. Huayanay-Espinoza IE, Guerra-Castanon F, Lazo-Poras M, Castaneda-Guaqrderas A, Thomas NJ, Garcia-Guarniz AL, et al. Metabolic control in patients with type 2 diabetes mellitus in a public hospital in Peru: a cross-sectional sudy in a low-middle income country. Peer J 2016; 4: e2577.

5. American Diabetes Association. 10. Cardiovascular disease and risk management: standards of medical care in diabetes - 2019. Diabetes Care 2019; 42(Suppl 1): S103‒23.

6. American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes - 2019. Diabetes Care 2019; 42(Suppl 1): S61‒70.

7. Rucket IA, Schunk M, Holle R, Schipf S, Volzke H, Kluttig A, et al. Blood pressure and lipid management fall far short in persons with type 2 diabetes: results from DIAB-CORE consortium including six German population-based studies. Cardiovasc Diabetol 2012; 11: 50.

8. American Diabetes Association. Improving care and promoting health in populations: Standards of Medical Care in Diabetes - 2019. Diabetes Care 2019; 42(Suppl 1): S7‒12.

9. American Diabetes Association. 6. Standards of medical care in diabetes - 2018. Diabetes Care 2018; 41(Suppl 1): S55‒64.

10. Fritz H, Di Zazzo-Miller R, Bertran EA, Pociask F D, Tarakji S, Arnetz J, et al. Diabetes self-management among Arab Americans: patients and provider perspectives. BMC Int Health Hum Rights 2016; 16: 22.

11. Stark Casagrande S, Fradkin JE, Saydah SH, Rust KF, Cowie C. The prevalence of meeting A1C, blood pressure and LDL goals among people with diabetes,1988-2010. Diabetes Care 2013; 36(8): 2271‒9.

12. Hood S, Irby-Shasanmi A, de Groot M, Martin E, LaJoie S. Understanding diabetes-related distress characteristics and psychosocial support preferences of urban African American adults living with type 2 diabetes. Diabetes Educ 2018; 44(2): 144‒57.

13. Jeong M, Reifsnider E. Associations of Diabetes-Related Distress and Depressive Symptoms With Glycemic Control in Korean Americans With Type 2 Diabetes. Diabetes Educ 2018; 44(6): 531‒40.

14. American Diabetes Association. 8. Obesity Management for the Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetes-2019. Diabetes Care 2019; 42(Suppl 1): S81‒9.

15. Prado-Aguilar CA, Martinez YV, Segovia-Bernal S, Reyes Martinez R, Arias-Ulloa A. Performance of two questionnaires to measure treatment adherence in patients with type 2 diabetes. BMC Public Health 2009; 9: 38.

16. Asaad G, Sadegian M, Lau R, Xu Y, Soria-Contreras DC, Bell RC, et al. The Reliability and Validity of the Perceived Dietary Adherence Questionnaire for People with Type 2 Diabetes. Nutrients 2015; 7(7): 5484‒96.

17. Ayele AA, Emiru YK, Tiruneh SA, Ayele BA, Gebremariam AD, Tegegn HG. Level of adherence to dietary recommendations and barriers among type 2 diabetic patients: a cross-sectional study in an Ethiopian hospital. Clin Diabetes Endocrinol 2018; 4: 21.

18. Stetson B, Schlundt D, Rothschild C, Floyd JE, Rogers W, Mokshagundam SP. Development and validation of The Personal Diabetes Questionnaire (PDQ): a measure of diabetes self-care behaviors, perceptions and barriers. Diabetes Res Clin Pract 2011; 91(3): 321‒32.

19. Majdan M, Krajcovicova L, Perkarickova J, Cherechees R, O’Mullane M. Predictors of depressive symptoms in patients with diabetes in Slovakia. Int J Psychiatry Med 2012; 44(4): 351‒66.

20. Fisher L, Hessler DM, Polonsky WH, Mullan J. When is diabetes distress clinically meaningful?: establishing cut points for the Diabetes Distress Scale. Diabetes Care 2012; 35(2): 259‒64.

21. Hu H, Hori A, Nishiura C, Sasaki N, Okazaki H, Nakagawa T, et al. HbA1c, blood pressure, and lipid control in people with diabetes: Japan epidemiology collaboration occupational health study. PloS ONE 2016; 11(7): e0159071.

22. Bała MM, Płaczkiewicz-Jankowska E, Leśniak W, Topór-Mądry R, Jankowski M, Grzeszczak W, et al. Under The Patronage Of Diabetes Poland For The Aretaeus-2 Study Group. Management and treatment goals in Polish patients with type 2 diabetes of more than ten years' duration - results of ARETAEUS2-Grupa Study. Endokrynol Pol 2014; 65(3): 158‒68.

23. Haghighatpanah M, Nejad ASM, Haghighatpanah M, Thunga G, Mallayasamy S. Factors that Correlate with Poor Glycemic Control in Type 2 Diabetes Mellitus Patients with Complications. Osong Public Health Res Perspect 2018; 9(4): 167‒74.

24. Chew BH, Sherina MS, Hassan NH. Association of diabetes-related distress, depression, medication adherence, and health-related quality of life with glycated hemoglobin, blood pressure, and lipids in adult patients with type 2 diabetes: a cross-sectional study. Ther Clin Risk Manag 2015; 11: 669‒81.

25. Ayele AA, Tegegn HG, Ayele TA, Ayalew MB. Medication regimen complexity and its impact on medication adherence and glycemic control among patients with type 2 diabetes mellitus in an Ethiopian general hospital. BMJ Open Diabetes Res Care 2019; 7(1): e000685.

26. Semenkovich K, Brown ME, Svrakic DM, Lustman PJ. Depression in type 2 diabetes mellitus: prevalence, impact, and treatment. Drugs 2015; 75(6): 577‒87.

27. Cols-Sagarra C, Lopez-Simarro F, Alonso-Fernandez M, Mancera-Romero J, Perez-Unanua P, Mediavilla-Bravo JJ, et al. Work Group of Diabetes SEMERGEN (Sociedad Española de Médicos de Atención Primaria). Prevalence of depression in patients with type 2 diabetes attended in primary care in Spain. Prim Care Diabetes 2016; 10(5): 369‒75.

28. Sonmez A, Yumuk V, Haymana C, Demirci I, Barcin C, Kıyıcı S, et al. TEMD Study Group. Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study). Obes Facts 2019; 12(2): 167‒78.

29. Ormazabal V, Nair S, Elfeky O, Aguayo. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol 2018; 17: 122.

30. Campbell MD, Babic D, Bolcina U, Smirčić-Duvnjak L, Tankova T, Mitrakou A, et al. High level of clinical inertia in insulin initiation in type 2 diabetes across Central and South-Eastern Europe: insights from SITIP study. Acta Diabetol 2019; 56(9): 1045‒9.

31. Wake AD. Antidiabetic Effects of Physical Activity: How It Helps to Control Type 2 Diabetes. Diabetes Metab Syndr Obes 2020; 13: 2909‒23.