Psychosocial factors associated with HbA_1c in adults with insulin pump‐treated type 1 diabetes: a systematic review

Abstract

Aims To identify currently available studies on the association between psychosocial factors and HbA 1c in adults with insulin pump-treated type 1 diabetes, by performing a systematic review of the literature. Methods MEDLINE, Embase, CINAHL and PsycINFO were searched for original studies on the association between psychosocial factors and HbA 1c in ≥ 50 adult, non-pregnant, insulin pump users with type 1 diabetes. Results The search resulted in 1777 unique records, of which eight were eligible for inclusion. All identified studies were observational, with sample sizes ranging from 51 to 214. Seven different psychosocial factors were investigated in the eight studies. Study analysis suggested that HbA 1c may be associated with diabetes numeracy and quality of life. There were no indications of associations between HbA 1c and fear of hypoglycaemia or self-efficacy. Results regarding associations between HbA 1c and coping style, diabetes distress and locus of control were inconsistent. Conclusions This systematic review summarizes the currently limited information on the association between psychosocial factors and HbA 1c during insulin pump therapy. The evidence base of the included studies was weak, and this review highlights the need for more research in these areas, with improved methodological and theoretical frameworks, including exploration of a broader spectrum of psychosocial variables and their potential association with HbA 1c and other metabolic outcomes. (PROSPERO International prospective register of systematic reviews registration no: CRD42020145705).

Unraveling the concepts of distress, burnout, and depression in type 1 diabetes: A scoping review

“…Studies have shown that management of T1D at optimal glycaemic levels can cause distress with constant blood glucose monitoring and concern over coping an acute hypoglycaemic event [39]. Positive associations between fear of hypoglycaemia and HbA1c have been demonstrated among those treated with insulin injections [40]. Conceptual words such as "management distress", "fear", and "worry", can be used to describe the anxiety and stress that people living with T1D might experience after their diabetes diagnosis (Figs.…”

‘Striving for freedom or remaining with what is well-known’: a focus-group study of self-management among people with type 1 diabetes who have suboptimal glycaemic control despite continuous subcutaneous insulin infusion

“…Furthermore, lower HbA1c levels relate to higher quality of life scores. The evidence regarding the associations between psychosocial factors and HbA1c levels among insulin pump users is however limited 16…”

Insulin Pump Treatment in Adults with Type 1 Diabetes in the Capital Region of Denmark: Design and Cohort Characteristics of the Steno Tech Survey

“…Questionnaire content was informed by preceding works by the Steno Tech study group, including systematic literature reviews [ 19 , 20 , 33 ] and an interview study with insulin pump users [ 24 ] that explored possibilities and barriers to effective daily insulin pump management. The Steno Tech study group is an interdisciplinary collaboration of researchers and clinicians with extensive experience in type 1 diabetes and insulin pump treatment.…”

“…However, there is currently no consensus on the best educational practice for a given patient [15,16], and there is a paucity of high-quality comparative studies regarding the effectiveness of insulin pump education [17][18][19]. Furthermore, psychosocial factors, such as self-efficacy, emotional (diabetes) distress and fear of hypoglycaemia, may also impact the use of technology and treatment outcomes, although the number of quantitative studies analysing the impact of these factors is limited [20,21]. Qualitative studies exploring how people live with an insulin pump suggest a variety of factors which may affect glucose levels and treatment satisfaction [22,23].…”