Associations of Well-Being and Perceived Stress with Diabetes Control and Self-Care Behavior in Adolescents with Type 1 Diabetes

Background: Psychosocial determinants of health are thought to play a significant role in type 1 diabetes (T1D) management. Higher rates of stress have also been shown to result in poorer health outcomes. The role that self-perceived well-being, stress, and barriers to diabetes care have in T1D outcomes is less well known.

Methods: At routine clinic visits, patients with known T1D completed a self-reported survey packet consisting of Perceived Stress Scale-4 (PSS), Diabetes Distress Scale-2 (DDS), and Global Well-Being Scale (GWB), as well as a novel barriers-to-care survey we developed. Inclusion criteria included all T1D patients older than 13 years of age (n=49); the instrument was administered to all participants recruited. Multivariate linear regression analysis assessed correlations between objective data (HgA1c and blood glucose checks per day) and the four self-reported measures.

Results: GWB scale was inversely correlated with HgA1C (R²=0.111; p=0.04) and positively correlated with glucose checks per day (R²=0.211; p=0.001). PSS scale was positively correlated with HgA1C (R²=0.109; p=0.04) and DDS was inversely correlated with glucose checks per day (R²=0.103; p=0.01). Increasing numbers of barriers trended toward positive correlation with HgA1C and inverse correlation with glucose checks per day but did not reach statistical significance.

Conclusion: Patient-reported markers of well-being and stress were predictive of home glucose monitoring frequency and glycemic control. The associations between HgA1C as well as glucose monitoring with well-being suggest that attention to assessing and optimizing positive psychological states may be valuable in achieving improved diabetes outcomes in adolescents with T1D.