Assessment of long-term glycemic control glycosylated hemoglobin and its correlation with psychological variables in patients with type 2 diabetes mellitus in an urban community setting

Abstract

INTRODUCTIONDiabetes mellitus (DM) is a chronic metabolic disease characterized by disorder in the metabolism of carbohydrates, lipids and amino acids either as a result of decreased insulin secretion or due to reduction to insulin sensitivity of the body cells, it is a disease that acquires epidemic form as Background: Patients with diabetes mellitus (DM) and their families may respond to the diagnosis, treatment, or complications of the disease with a variety of feelings, such as guilt anxiety depression or stress. The presence of diabetes changes one's life and creates demand of treatment. Not only emotions directly affect glycemia; emotional stress may disrupt the individual's eating habits, exercise programs, and daily routine, thereby altering daily diabetes management and impairing glycemic control. Existing literature suggests that depression may be more strongly related with glycemic control. Frustration to achieve good glycemic control could lead to depression. In addition, diabetes often serves as a focus for other problems and conflicts in life; in turn, diabetes may be influenced by these life stresses. Objectives: To assess long-term glycemic control (past three months) by glycosylated hemoglobin (HbA1c) in type 2 DM patients in an urban community setting. To study association between psychological variables (anxiety, depression, and stress) and HbA1c. Materials and Methods: It is a community-based cross-sectional study. 183 study subjects selected from urban community who were already diagnosed of type 2 DM with active treatment for more than 6 months. Stress, depression, and anxiety were the psychological factors evaluated individually in each study subjects using standard questionnaire. HbA1c was done by standardized high pressure liquid chromatography technique. Results: Out of 183 study subjects, 140 (i.e., 76.5%) subjects have fair glycemic control and 40 (23.5%) have poor glycemic control. 140 subjects (76.5%) have an anxiety scale reading of <14 and 43 subjects (23.5%) have a reading of more than or equal to 14. Out of 183 subjects, 47 subjects (25.7%) are depressed (mild, moderate, or severe categories). 136 subjects (74.3%) do not suffer from depression. 134 subjects (73.2%) have low susceptibility to stress related illness and 49 subjects (26.8%) have medium susceptibility to stress related illness. All the psychological variables, i.e., anxiety (χ 2 = 32.655, P < 0.0001), depression (χ 2 = 40.549, P < 0.0001), and stress (χ 2 = 17.049, P < 0.0001) were found to very highly significantly associated with poor glycemic control. Conclusion: The study shows that there is a strong association between psychological variables and poor glycemic control.