Individual differences in impulsivity and need for cognition as potential risk or resilience factors of diabetes self-management and glycemic control

Alexander Hadj-Abo, Sören Enge, Jörn Rose, Hagen Kunte, Monika Fleischhauer, Alexander Hadj-Abo, Sören Enge, Jörn Rose, Hagen Kunte, Monika Fleischhauer

Abstract

Objective: Impulsivity is marked by insufficient reflection and forethought, whereas Need for Cognition (NFC) also referred to as cognitive motivation or intellectual engagement is marked by elaborated thinking. The aim of this study was to investigate the potential role of these personality traits as resilience or risk factors, respectively, in diabetes self-management and glycaemic control. Further, it was examined whether diabetes-specific self-efficacy could serve as a mediator of these relationships.

Design/measures: Data of 77 participants with type 2 diabetes was ascertained, using self-report instruments for NFC, impulsivity, diabetes-specific self-efficacy, and diabetes self-management. Glycemic control was assessed by the biomarker HbA1c.

Results: While NFC was strongly positively associated with diabetes self-management and glycemic control, impulsivity showed a reverse pattern. Results of simple and serial mediation models showed that the effects on diabetes self-management and HbA1c of both, impulsivity and NFC, were mediated by self-efficacy.

Conclusion: The moderate to high standardized coefficients suggests that NFC might be an important protective factor and impulsivity a possible risk factor for effective diabetes self-management and glycemic control. These traits could be applied for an easy-to-use questionnaire-based patient screening, enabling trait-tailored treatments and programs which in turn may lower economic and health costs associated with poor diabetes-care.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Relationship between impulsivity and diabetes…
Fig 1. Relationship between impulsivity and diabetes self-management mediated by diabetes-specific self-efficacy.
*p < .05, **p < .01.
Fig 2. Relationship between Need for Cognition…
Fig 2. Relationship between Need for Cognition and diabetes self-management mediated by diabetes-specific self-efficacy.
*p < .05, **p < .01.
Fig 3. Relationship between impulsivity and HbA…
Fig 3. Relationship between impulsivity and HbA1c mediated by self-efficacy and self-management.
*p < .05, **p < .01.
Fig 4. Relationship between Need for Cognition…
Fig 4. Relationship between Need for Cognition and HbA1c mediated by self-efficacy and self-management.
*p < .05, **p < .01.

References

    1. Alberti KGMM, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation. Diabetic Medicine. 1998;15(7):539–53. 10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>;2-S
    1. International Diabetes Federation. IDF Diabetes Atlas, 8th edn. Brussels, Belgium: International Diabetes Federation; 2017 [cited 2018 05.04.2018]. .
    1. Bruno G, Runzo C, Cavallo-Perin P, Merletti F, Rivetti M, Pinach S, et al. Incidence of Type 1 and Type 2 Diabetes in Adults Aged 30–49 Years. The population-based registry in the province of Turin, Italy. 2005;28(11):2613–9.
    1. Holman N, Young B, Gadsby R. What is the current prevalence of diagnosed and yet to be diagnosed diabetes in the UK. Diabetic Medicine. 2014;31(5):510–1. 10.1111/dme.12397
    1. Seuring T, Archangelidi O, Suhrcke M. The Economic Costs of Type 2 Diabetes: A Global Systematic Review. PharmacoEconomics. 2015;33(8):811–31. 10.1007/s40273-015-0268-9
    1. Tönnies T, Röckl S, Hoyer A, Heidemann C, Baumert J, Du Y, et al. Projected number of people with diagnosed Type 2 diabetes in Germany in 2040. Diabetic Medicine. 2019.
    1. Adeghate E, Schattner P, Dunn E. An update on the etiology and epidemiology of diabetes mellitus. Annals of the New York Academy of Sciences. 2006;1084(1):1–29.
    1. Cnop M, Welsh N, Jonas J-C, Jörns A, Lenzen S, Eizirik DL. Mechanisms of pancreatic β-cell death in type 1 and type 2 diabetes: many differences, few similarities. Diabetes. 2005;54(suppl 2):S97–S107.
    1. Eppens MC, Craig ME, Cusumano J, Hing S, Chan AK, Howard NJ, et al. Prevalence of diabetes complications in adolescents with type 2 compared with type 1 diabetes. Diabetes Care. 2006;29(6):1300–6. Epub 2006/05/30. 10.2337/dc05-2470 .
    1. Eckstrand KL, Mummareddy N, Kang H, Cowan R, Zhou M, Zald D, et al. An insulin resistance associated neural correlate of impulsivity in type 2 diabetes mellitus. PLoS One. 2017;12(12):e0189113 Epub 2017/12/12. 10.1371/journal.pone.0189113
    1. Sarwar N. G P, Seshasai SR., Gobin R., Kaptoge S., Di Angelantonio et al. Lancet.. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. The Lancet. 2010;375(9733):2215–22.
    1. World Health Organisation. Fact Sheet Diabetes: World Health Organisation; 2017 [cited 2018 05.04.2018]. .
    1. Saran R, Li Y, Robinson B, Ayanian J, Balkrishnan R, Bragg-Gresham J, et al. US Renal Data System 2014 Annual Data Report: Epidemiology of Kidney Disease in the United States. American Journal of Kidney Diseases. 2014;66(1):A7 10.1053/j.ajkd.2015.05.001
    1. Tuomilehto J, Rastenyte D, Jousilahti P, Sarti C, Vartiainen E. Diabetes mellitus as a risk factor for death from stroke: prospective study of the middle-aged Finnish population. Stroke. 1996;27(2):210–5. 10.1161/01.str.27.2.210
    1. Steinsbekk A, Rygg L, Lisulo M, Rise MB, Fretheim A. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Services Research. 2012;12(1):213 10.1186/1472-6963-12-213
    1. Chen PC, Chan YT, Chen HF, Ko MC, Li CY. Population-based cohort analyses of the bidirectional relationship between type 2 diabetes and depression. Diabetes Care. 2013;36(2):376–82. Epub 2012/11/15. 10.2337/dc12-0473
    1. Pan A, Lucas M, Sun Q, et al. Bidirectional association between depression and type 2 diabetes mellitus in women. Archives of Internal Medicine. 2010;170(21):1884–91. 10.1001/archinternmed.2010.356
    1. Semenkovich K, Brown ME, Svrakic DM, Lustman PJ. Depression in type 2 diabetes mellitus: prevalence, impact, and treatment. Drugs. 2015;75(6):577–87. Epub 2015/04/09. 10.1007/s40265-015-0347-4 .
    1. Çelik S, Kayar Y, Önem Akçakaya R, Türkyılmaz Uyar E, Kalkan K, Yazısız V, et al. Correlation of binge eating disorder with level of depression and glycemic control in type 2 diabetes mellitus patients. General Hospital Psychiatry. 2015;37(2):116–9. 10.1016/j.genhosppsych.2014.11.012
    1. Crow S, Kendall D, Praus B, Thuras P. Binge eating and other psychopathology in patients with type II diabetes mellitus. International Journal of Eating Disorders. 2001;30(2):222–6. 10.1002/eat.1077
    1. Kenardy J, Mensch M, Bowen K, Green B, Walton J, Dalton M. Disordered eating behaviours in women with Type 2 diabetes mellitus. Eating Behaviors. 2001;2(2):183–92. 10.1016/S1471-0153(01)00028-9
    1. de Jonge P, Alonso J, Stein DJ, Kiejna A, Aguilar-Gaxiola S, Viana MC, et al. Associations between DSM-IV mental disorders and diabetes mellitus: a role for impulse control disorders and depression. Diabetologia. 2014;57(4):699–709. Epub 2014/02/04. 10.1007/s00125-013-3157-9
    1. Ulrich S, Holle R, Wacker M, Stark R, Icks A, Thorand B, et al. Cost burden of type 2 diabetes in Germany: results from the population-based KORA studies. BMJ Open. 2016;6(11). 10.1136/bmjopen-2016-012527
    1. Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient Education and Counseling. 2002;48(2):177–87. 10.1016/S0738-3991(02)00032-0
    1. Fransen MP, von Wagner C, Essink-Bot M-L. Diabetes self-management in patients with low health literacy: Ordering findings from literature in a health literacy framework. Patient Education and Counseling. 2012;88(1):44–53. 10.1016/j.pec.2011.11.015
    1. Kamradt M, Bozorgmehr K, Krisam J, Freund T, Kiel M, Qreini M, et al. Assessing self-management in patients with diabetes mellitus type 2 in Germany: validation of a German version of the Summary of Diabetes Self-Care Activities measure (SDSCA-G). Health Qual Life Outcomes. 2014;12:185 Epub 2014/12/19. 10.1186/s12955-014-0185-1
    1. Jarvis J, Skinner TC, Carey ME, Davies MJ. How can structured self-management patient education improve outcomes in people with type 2 diabetes? Diabetes Obes Metab. 2010;12(1):12–9. Epub 2009/10/01. 10.1111/j.1463-1326.2009.01098.x .
    1. Costa PT, McCrea RR. Revised neo personality inventory (neo pi-r) and neo five-factor inventory (neo-ffi): Psychological Assessment Resources; 1992.
    1. Čukić I, Mõttus R, Realo A, Allik J. Elucidating the links between personality traits and diabetes mellitus: Examining the role of facets, assessment methods, and selected mediators. Personality and Individual Differences. 2016;94:377–82.
    1. Skinner TC, Bruce DG, Davis TM, Davis WA. Personality traits, self-care behaviours and glycaemic control in type 2 diabetes: the Fremantle diabetes study phase II. Diabet Med. 2014;31(4):487–92. Epub 2013/10/24. 10.1111/dme.12339 .
    1. Keweloh WC, Zillich F, Wick K, Müller N, Kloos C, Lehmann T, et al. Assoziation von glykämischer Kontrolle und Hypoglykämien mit Persönlichkeitsvariablen und Resilienz bei Patienten mit Diabetes mellitus. Diabetologie und Stoffwechsel. 2013;8(S 01):FV49 10.1055/s-0033-1341709
    1. Preuss UW, Rujescu D, Giegling I, Watzke S, Koller G, Zetzsche T, et al. [Psychometric evaluation of the German version of the Barratt Impulsiveness Scale]. Nervenarzt. 2008;79(3):305–19. Epub 2008/01/23. 10.1007/s00115-007-2360-7 .
    1. Stupiansky NW, Hanna KM, Slaven JE, Weaver MT, Fortenberry JD. Impulse control, diabetes-specific self-efficacy, and diabetes management among emerging adults with type 1 diabetes. J Pediatr Psychol. 2013;38(3):247–54. Epub 2012/11/02. 10.1093/jpepsy/jss110
    1. Goodwin RD, Cox BJ, Clara I. Neuroticism and Physical Disorders Among Adults in the Community: Results from the National Comorbidity Survey. Journal of Behavioral Medicine. 2006;29(3):229–38. 10.1007/s10865-006-9048-5
    1. Terracciano A, Sutin AR, McCrae RR, Deiana B, Ferrucci L, Schlessinger D, et al. Facets of personality linked to underweight and overweight. Psychosomatic medicine. 2009;71(6):682 10.1097/PSY.0b013e3181a2925b
    1. Tsenkova VK, Carr D, Coe CL, Ryff CD. Synergistic effect of neuroticism and body mass index on glucose metabolism in nondiabetic adults. Psychotherapy and psychosomatics. 2012;81(5):327–8. 10.1159/000337413
    1. Jacobs E, Hoyer A, Brinks R, Icks A, Kuß O, Rathmann W. Healthcare costs of Type 2 diabetes in Germany. Diabetic Medicine. 2017;34(6):855–61. 10.1111/dme.13336
    1. Eisenstein SA, Gredysa DM, Antenor–Dorsey JA, Green L, Arbelaez AM, Koller JM, et al. Insulin, central dopamine D2 receptors, and monetary reward discounting in obesity. PloS one. 2015;10(7):e0133621 10.1371/journal.pone.0133621
    1. Bottiroli S, Vecchi T, Campanella F, Varetta A, Gallotti MC, Perego E, et al. Executive Functioning in Older Adult Outpatients With Type 2 Diabetes Mellitus: A Preliminary Study. Clinical Gerontologist. 2014;37(2):91–107. 10.1080/07317115.2013.868846
    1. Smith MA, Else JE, Paul L, Foster JK, Walker M, Wesnes KA, et al. Functional Living in Older Adults With Type 2 Diabetes: Executive Functioning, Dual Task Performance, and the Impact on Postural Stability and Motor Control. J Aging Health. 2014;26(5):841–59. Epub 2014/06/06. 10.1177/0898264314534896 .
    1. Cacioppo JT, Petty RE, Feinstein JA, Jarvis WBG. Dispositional differences in cognitive motivation: The life and times of individuals varying in need for cognition. Psychological bulletin. 1996;119(2):197.
    1. Fleischhauer M, Enge S, Brocke B, Ullrich J, Strobel A, Strobel A. Same or different? Clarifying the relationship of need for cognition to personality and intelligence. Personality and Social Psychology Bulletin. 2010;36(1):82–96. 10.1177/0146167209351886
    1. Shim U, Oh J-Y, Lee H, Sung Y-A, Kim H-N, Kim H-L. Association between extraversion personality and abnormal glucose regulation in young Korean women. Acta diabetologica. 2014;51(3):421–7. 10.1007/s00592-013-0529-z
    1. Reid JC, Klachko DM, Kardash CAM, Robinson RD, Scholes R, Howard D. Why people don’t learn from diabetes literature: influence of text and reader characteristics. Patient education and counseling. 1995;25(1):31–8. 10.1016/0738-3991(94)00688-i
    1. Fleischhauer M, Miller R, Wekenborg MK, Penz M, Kirschbaum C, Enge S. Thinking against burnout? An individual’s tendency to engage in and enjoy thinking as a potential resilience factor of burnout symptoms and burnout-related impairment in executive functioning. Frontiers in Psychology. 2019;10.
    1. Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Advances in Behaviour Research and Therapy. 1978;1(4):139–61. 10.1016/0146-6402(78)90002-4.
    1. Cherrington A, Wallston KA, Rothman RL. Exploring the relationship between diabetes self-efficacy, depressive symptoms, and glycemic control among men and women with type 2 diabetes. J Behav Med. 2010;33(1):81–9. Epub 2010/02/04. 10.1007/s10865-009-9233-4
    1. Venkataraman K, Kannan AT, Kalra OP, Gambhir JK, Sharma AK, Sundaram KR, et al. Diabetes self-efficacy strongly influences actual control of diabetes in patients attending a tertiary hospital in India. J Community Health. 2012;37(3):653–62. Epub 2011/11/04. 10.1007/s10900-011-9496-x .
    1. Al-Khawaldeh OA, Al-Hassan MA, Froelicher ES. Self-efficacy, self-management, and glycemic control in adults with type 2 diabetes mellitus. Journal of Diabetes and its Complications. 2012;26(1):10–6. 10.1016/j.jdiacomp.2011.11.002
    1. Lee YJ, Shin SJ, Wang RH, Lin KD, Lee YL, Wang YH. Pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus. Patient Educ Couns. 2016;99(2):287–94. Epub 2015/09/06. 10.1016/j.pec.2015.08.021 .
    1. Dutton GR, Tan F, Provost BC, Sorenson JL, Allen B, Smith D. Relationship between self-efficacy and physical activity among patients with type 2 diabetes. J Behav Med. 2009;32(3):270–7. Epub 2009/01/22. 10.1007/s10865-009-9200-0 .
    1. Tregea H, Lee C, Browne JL, Pouwer F, Speight J. Does self-efficacy mediate the cross-sectional relationship between perceived quality of health care and self-management of diabetes? Results from Diabetes MILES—Australia. Psychol Health. 2016;31(5):592–604. Epub 2015/12/10. 10.1080/08870446.2015.1128543 .
    1. Sarkar U, Fisher L, Schillinger D. Is Self-Efficacy Associated With Diabetes Self-Management Across Race/Ethnicity and Health Literacy? Diabetes Care. 2006;29(4):823–9. 10.2337/diacare.29.04.06.dc05-1615
    1. Gullo MJ, Dawe S, Kambouropoulos N, Staiger PK, Jackson CJ. Alcohol expectancies and drinking refusal self-efficacy mediate the association of impulsivity with alcohol misuse. Alcoholism: Clinical and Experimental Research. 2010;34(8):1386–99.
    1. Hayaki J, Herman DS, Hagerty CE, de Dios MA, Anderson BJ, Stein MD. Expectancies and self-efficacy mediate the effects of impulsivity on marijuana use outcomes: an application of the acquired preparedness model. Addict Behav. 2011;36(4):389–96. Epub 2011/01/11. 10.1016/j.addbeh.2010.12.018
    1. Rammstedt B, Kemper CJ, Klein MC, Beierlein C, Kovaleva A. Eine kurze Skala zur Messung der fünf Dimensionen der Persönlichkeit: Big-Five-Inventory-10 (BFI-10). 2012.
    1. Beißert H, Köhler M, Rempel M, Beierlein C. Eine Deutschsprachige Kurzskala zur Messung des Konstrukts Need for Cognition: Die Need for Cognition Kurzskala (NFC-K). 2014.
    1. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23(7):943–50. 10.2337/diacare.23.7.943
    1. Sturt J, Hearnshaw H, Wakelin M. Validity and reliability of the DMSES UK: a measure of self-efficacy for type 2 diabetes self-management. Primary Health Care Research & Development. 2010;11(04):374–81. 10.1017/s1463423610000101
    1. Jeffcoate S. Diabetes control and complications: the role of glycated haemoglobin, 25 years on. Diabetic Medicine. 2004;21(7):657–65. 10.1046/j.1464-5491.2003.01065.x
    1. Field A. Discovering statistics using IBM SPSS statistics. 4 ed London: Sage publications; 2013.
    1. Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York, NY: The Guilford Press. Journal of Educational Measurement. 2014;51(3):335–7.
    1. Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior research methods. 2009;41(4):1149–60. 10.3758/BRM.41.4.1149
    1. Nam S, Chesla C, Stotts NA, Kroon L, Janson SL. Barriers to diabetes management: patient and provider factors. Diabetes research and clinical practice. 2011;93(1):1–9. 10.1016/j.diabres.2011.02.002
    1. Richard AA, Shea K. Delineation of self-care and associated concepts. Journal of Nursing Scholarship. 2011;43(3):255–64. 10.1111/j.1547-5069.2011.01404.x
    1. Enge S, Fleischhauer M, Brocke B, Strobel A. Neurophysiological measures of involuntary and voluntary attention allocation and dispositional differences in need for cognition. Personality and Social Psychology Bulletin. 2008;34(6):862–74. 10.1177/0146167208315556
    1. Patton JH. Factor-Structure-of-the-Barratt-Impulsiveness-Scale. J Clin Psychol. 1995;51:768–74. 10.1002/1097-4679(199511)51:6<768::aid-jclp2270510607>;2-1
    1. Whiteside SP, Lynam DR. The five factor model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and individual differences. 2001;30(4):669–89.
    1. Peyrot M, McMurry JF Jr, Kruger DF. A biopsychosocial model of glycemic control in diabetes: stress, coping and regimen adherence. Journal of health and social behavior. 1999:141–58.
    1. Cozma AI, Sievenpiper JL, De Souza RJ, Chiavaroli L, Ha V, Wang DD, et al. Effect of fructose on glycemic control in diabetes: a systematic review and meta-analysis of controlled feeding trials. Diabetes care. 2012;35(7):1611–20. 10.2337/dc12-0073
    1. Nikoloudakis I, Crutzen R, Rebar AL, Vandelanotte C, Quester P, Dry M, et al. Can you elaborate on that? Addressing participants’ need for cognition in computer-tailored health behavior interventions. Health psychology review. 2018;12(4):437–52. 10.1080/17437199.2018.1525571
    1. Joinson A. Social desirability, anonymity, and Internet-based questionnaires. Behavior Research Methods, Instruments, & Computers. 1999;31(3):433–8.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する