cron-web.org

[A1CR]

[from MR; 2001-08-03]

Diabetes Care 2000 Sep;23(9):1321-5

Personality correlates of glycemic control in type 2 diabetes.

Lane JD, McCaskill CC, Williams PG, Parekh PI, Feinglos MN, Surwit RS.

OBJECTIVE: To determine whether traits of normal personality are
associated with
variations in glycemic control in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS: A longitudinal cohort study was conducted
using data from 105 type 2 diabetic patients ... Before treatment
assignment, patients completed the NEO Personality Inventory, ...
Glycemic control was assessed by measures of HbA1c and average blood
glucose levels ... Relationships between personality traits and measures
of glycemic control were examined by correlation and linear regression
models that were adjusted for age, sex, race, duration of diabetes,
medication status, and experimental treatment.

RESULTS: Lower average blood glucose values at baseline were associated
with higher scores for the personality domain of neuroticism and several
specific traits including anxiety, angry hostility, depression,
self-consciousness, and
vulnerability, but were associated with lower scores for the trait of
altruism

... The relative tendency to experience fewer negative emotions and to
focus on the needs of others instead of oneself could prove to be a risk
factor for poor glycemic control.

PMID: 10977026

"These results offer preliminary evidence that common personality traits
may help to explain variations in glycemic control achieved by patients
with type 2 diabetes under conditions of standard diabetes management.
... People with higher neuroticism scores are more prone to experience
negative emotions, which include a greater tendency to worry; experience
anger and frustration; experience guilt, sadness, and hopelessness; feel
self-conscious; and feel less able to cope with stress. In contrast,
people with lower neuroticism scores are usually described as "calm,
even-tempered, and relaxed," and "able to face stressful situations
without becoming upset or rattled" (7). Stronger tendencies to worry and
experience other negative emotions may provide increased motivation for
a patient with diabetes to follow the necessary self-care regimen and
achieve a better clinical outcome."

"Fawzy et al. (8) offered a similar interpretation when they found that
higher levels of total mood disturbance (experience of negative moods)
were associated with better survival after surgery for melanoma. These
authors suggested that individuals who presented with lower levels of
distress may have minimized the importance and threat of cancer to their
well-being. Lacking a sense of distress, they lacked the motivation to
mobilize the coping resources needed to deal with the psychological and
physical adjustments required by the disease. The same may be true in
type 2 diabetes. Patients who report low levels of neuroticism may lack
the emotional distress necessary to motivate them to maintain proper
self-care. They may minimize the long-term consequences of failing to
maintain control and the severe health impact that diabetes
complications will have on their future well-being. As a result, their
glycemic control can suffer."

"People with high scores for altruism are described as having 'an active
concern for others' welfare as shown in generosity, consideration of
others, and a willingness to assist others in need of help.' Those with
low altruism scores are described as being 'somewhat more self-centered
and…reluctant to get involved in the problems of others.' The link
between higher altruism and worse glycemic control may also be explained
by the mechanism of self-care. People who are more concerned about the
needs of others than their own needs may tend to neglect their own
self-care in serving the needs and interests of friends and family
members. Proper diabetes management may require a modest degree of
self-centeredness to overcome social and familial barriers to regimen adherence."

"Brickman et al. (10) investigated the interaction of neuroticism and
conscientiousness in determining the length of time before renal
deterioration as an index of successful management in a sample of
patients with type 1 diabetes with end-stage renal disease. The
combination of high levels of conscientiousness and moderate neuroticism
was associated with slower renal deterioration than the combination of
lower levels of conscientiousness with either high or low levels of
neuroticism. However, neither neuroticism nor conscientiousness was
itself related to the clinical outcome, and no measure of actual
glycemic control was available. ..."

"[R]esearch on personality traits in diabetes may offer new insights
that can enhance diabetes management. ... Our results suggest, for
example, that a little worry and a little selfishness may benefit
patients with diabetes. Diabetes educators may need to overcome the risk
minimization present in patients with low neuroticism and motivate these
patients to understand and accept the realistic threats to their health
that are associated with poor glycemic control. Other patients may need
to become more assertive about their own self-care when faced with the
needs of family members and friends. Recognizing these personality
traits and changing the associated attitudes and behaviors may
contribute to improved diabetes management."

8. Fawzy FI, Fawzy NW, Hyun CS, Elashoff R, Guthrie D, Fahey JL, Morton DL.
Malignant melanoma. Effects of an early structured psychiatric intervention,
coping, and affective state on recurrence and survival 6 years later.
Arch Gen Psychiatry. 1993 Sep;50(9):681-9.
PMID: 8357293

10. Brickman AL, Yount SE, Blaney NT, Rothberg ST, De-Nour AK.
Personality traits and long-term health status. The influence of
neuroticism and conscientiousness on renal deterioration in type-1 diabetes.
Psychosomatics. 1996 Sep-Oct;37(5):459-68.
PMID: 8824126

There are all kinds of value judgements in the choice of adjectives, of
course, but the general point is clear. Self-absorption &a tendency to
be harder on oneself &others (to hold all to a high standard, one might
say less pejoratively) are personality traits which help motivate a
person to adhere more strictly to a regimen, &to be willing to discount
social pressures &even concerns w/others' feelings &well-being in
pursuit of one's (intrinsically selfish) health goals.

These data strongly suggest that such a personality configuration this
leads to real increses in adherence: that appears to me to be the only
reasonable interpretation of the measurable improvements observed in the
variables which the regimen is designed to influence.

I believe that these results are extendable to CR; I also expect that
(because of cognitive dissonance) this will work both ways -- ie. people
who manage to stick with CR will, over time, tend to become more
self-controlling &inwardly-focussed ("neurotic"), hold themselves &
others to higher standards ("angry hostility," "self-consciousness,"
etc) & perhaps be less caring toward our fellow human beings.

I also THINK I may have noted a correlation between self-described
"cruiser" vs. "struggler" status &apparent matching with the 2
personality types.

This is at once advice for CR success -- &a warning about a potential
attendant psycholocgical risks. Frankly, in my neurotic, misanthropic
opinion, most people need more of many of these traits; but fairly
clearly, CR might inflate such traits to pathological levels in those of
us who already strongly exhibit them.

Now THERE's a "negative," self-critical post for yuz .

-MR