Стратегии совладания (копинг-стратегии) у больных сахарным диабетом 1 и 2 типа на инсулинотерапии: связь с эмоциональным благополучием и уровнем гликемического контроля

Abstract

Background . Over the long disease course of diabetes mellitus (DM), with its demands in terms of everyday self-management of the disease, individual psychological characteristics may be associated with both emotional well-being (WB) and glycaemic control. The former includes various types of coping strategies (CSs) of the patients, which comprise the common ways for patients to overcome difficult situations. Aim . To study the relationships between CS and both glycaemic control and emotional WB in patients with Type 1 diabetes (T1D) and Type 2 diabetes (T2D) treated with insulin. Materials and methods . The study included 84 patients with T1D and 56 patients with insulin-treated T2D [age, 22.5 ± 3.3 and 61.0 ± 8.9 years; men/women, 29/55 and 11/45; duration of DM, 11.9 ± 5.36 and 11.6 ± 6.2 years and glycated haemoglobin (HbA1c), 9.1% ± 2.2% and 9.0% ± 1.4%, respectively]. The HbA1c levels were determined in all patients. The Strategic Approach to Coping Scale constructed by S. Hobfoll was used to study CS, and emotional WB was assessed based on the severity of anxiety and depression. Further, we used the State-Trait Anxiety Inventory developed by C.D. Spielberger and adapted by Y.L. Khanin and the Center for Epidemiologic Studies Depression Scale. Only Russian validated versions of the questionnaires were used in the study. Results . In both groups of patients, ‘Assertive (Persistent) Actions’ was positively associated with emotional WB. In patients with T2D, WB increases when using ‘Cautious Action’ and ‘Social Joining’. The deterioration of emotional WB was associated with ‘Aggressive Actions’ in both groups of patients. In patients with T1D, negative WB was also associated with ‘Avoidance’, while in patients with T2D, negative WB was associated with ‘Instinctive Actions’. In patients with T1D, ‘Instinctive Action’ was associated with higher HbA1c levels. In patients with T2D, ‘Cautious Action’, ‘Avoidance’ and ‘Antisocial Action’ were associated with lower HbA1c levels. Conclusion . In patients with T1D and T2D, CSs are associated with both emotional WB and glycaemic control. Emotional WB and lower HbA1c levels are associated with ‘Assertive Action’, ‘Cautious Action’, ‘Avoidance’ and ‘Asocial Action’. Negative WB and higher HbA1c levels are associated with ‘Aggressive Action’ and ‘Instinctive Action’.