Interpersonal Predictors of HbA1c in Patients With Type 1 Diabetes

Abstract

OBJECTIVE—Research suggests that increased collaboration and satisfaction in the patient-provider relationship is associated with better outcomes in patients with diabetes. In adults, an interpersonal style characterized by low trust of others and excessive self-reliance is known as “dismissing attachment style.” We hypothesized that diabetic patients with dismissing attachment style, due to a decreased ability to collaborate with providers and others, would have significantly higher HbA1c levels than patients with secure attachment style. RESEARCH DESIGN AND METHODS—From 276 adult tertiary care patients with type 1 diabetes, we obtained mean HbA1c levels over the prior year and assessed patient attachment style, demographics, and clinical characteristics. We used χ2 tests and logistic regression to determine whether attachment style was associated with HbA1c levels. RESULTS—We found that 62% of patients with dismissing attachment style had mean HbA1c levels ≥8% compared with 34% of patients with secure attachment style (P = 0.002). After adjusting for demographics, diabetes severity, medical comorbidity, and depression, dismissing attachment style remained significantly associated with HbA1c levels ≥8%, compared with secure attachment style (odds ratio 2.5, 95% CI 1.1–6.0). CONCLUSIONS—We have found that dismissing attachment style is associated with a higher risk for poor glycemic control. This has relevance from a population-based perspective because ∼25% of the general population has a dismissing attachment style. Attachment style is easily measured using self-report instruments and may inform clinicians how to work with patients who are less engaged in the health care relationship.