Interpersonal predictors of HbA1c in patients with type 1 diabetes

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 attach-ment 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 attach-ment style, demographics, and clinical characteristics. We used 2 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, dis-missing 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 because25 % 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