What makes poor diabetic control worse? A cross-sectional survey of biopsychosocial factors among patients with poorly controlled diabetes mellitus in Malaysia

Abstract

Diabetes mellitus (DM) is an increasingly prevalent condition that is associated with significant complications, especially when glycemic control is poor. This study explored what biopsychosocial factors are associated with poor vs. very poor glycemic control among Malaysian patients with sub-optimal glycated hemoglobin (HbA1c) levels. This cross-sectional study recruited diabetic patients with poor glycemic control (HbA1c ≥ 7.0%) from the Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Malaysia. The Generalized Anxiety Disorder (GAD)-7, Beck Depression Inventory (BDI) and Big Five Inventory (BFI) questionnaires assessed for anxiety, depression and personality traits, respectively. Multivariate logistic regression analysis was performed to evaluate associations between biopsychosocial factors and the occurrence of poor vs. very poor glycemic control, using the median HbA1c level of the study sample as the cutoff point. The median age of participants (n = 176) was 61.5 years. The median duration of diabetes was 15.0 years, and the median HbA1c level was 8.5%. Very poor control of diabetes (HbA1c > 8.5%) was associated with younger age, single status, retirement, hypertension and dyslipidemia in bivariate analysis. However, in the final multivariate regression model, only agreeableness was associated with very poor glycemic control (p < 0.01). There were no differences in depression and anxiety scores between the poor and very poor glycemic control groups. This study suggests that the agreeableness personality trait may be associated with very poor glycemic control. The effects of personality traits on glycemic control might be influenced by sociocultural factors. Further investigations are needed to provide a better understanding of this area.