The importance of attachment has been studied extensively as a frame for understanding the self-care behaviours of people with diabetes and their relations with practitioners. A component of attachment is the ability to reflect upon one’s mental state and understand what one is feeling and why.

Aim of the study was to investigate attachment patterns and their relation with the reflective function of people with type 1 diabetes. 102 people (age 38.6±10 years, 63% females, diabetes duration 21.3±13 years, HbA1c 7.5±1.2%, Gold Score 2.2±1.5) completed measures of attachment (ECR-R) and reflective functioning (RFQ). Results suggested that there were differences in the attachment styles (χ2= 9.04, p= 0.02) between individuals who were able to detect hypoglycemia symptoms quickly enough to avoid progression to a severe hypoglycemic episode and those with hypoglycemia unawareness. 63.6% (p< 0.001) of participants with hypoglycemia unawareness were characterized as fearfully attached, a pattern associated with emotional dysregulation and problems in interpersonal relationships. People with impaired reflective functioning were more likely to report hypoglycemia unawareness (t= 2.74, p= 0.007) suggesting that impairments in identifying and expressing emotional states are associated with the ability to recognize hypoglycemic symptoms. Mediation analysis revealed significant indirect effects with a point estimate of b= 0.128 (SE= 0.055), excluding zero (95% CI= 0.033, 0.248) for anxiety and b= 0.109 (SE= 0.052), excluding zero (95% CI = 0.019, 0.226) for avoidance, indicating that attachment insecurities indirectly influence hypoglycemia awareness via the capacity to recognize and understand one’s own and other’s psychological state. Overall, the results indicate that impaired reflective processes may be involved in the recognition of hypoglycemia. Therapeutic interventions designed to enhance reflective functioning could improve hypoglycemia awareness.


P. Thomakos: None. F. Griva: None. O. Kepaptsoglou: None. A. Mitrakou: None. G. Vaslamatzis: None. C. Zoupas: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at