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Parallel Mediation Model Linking Type D Personality with Adverse Health Outcomes in People with Type 2 Diabetes


 Background: This study aims to investigate a parallel mediation model to directly link Type D personality with adverse glycated hemoglobin (HbA1c) health outcomes and health-related quality of life (HRQOL), and indirectly through diabetes distress and social isolation in people with type 2 diabetes.Methods: Secondary data analysis of a cross-sectional survey was used. Data on 524 people with type 2 diabetes from June 2020 to February 2021 were recruited from outpatient clinics. The analyzed components of the data set were Type D personality, diabetes distress, social isolation, HbA1c, and health-related quality of life (HRQOL). The hypothesized parallel mediation model was tested using the PROCESS macro for SPSS. A 10,000-bootstrap bias-corrected procedure was used to estimate 95% confidence intervals for indirect effects.Results: Type D personality was present in 31.3% of the participants. The direct effect of Type D personality on HbA1c was insignificant, but was significant on HRQOL. The indirect effects of Type D personality on HbA1c and HRQOL through diabetes distress and social isolation were both significant. The indirect effect on HRQOL through diabetes distress was greater than that through social isolation.Conclusion: People with a Type D personality more often experienced negative emotions in response to the burden of living with and managing diabetes and might have fewer interpersonal contacts, which in turn impair glycemic control and HRQOL. This study identified the mechanisms underlying the relationship between Type D personality and glycemic control and HRQOL in people with type 2 diabetes. Both diabetes distress and social isolation mediated these relationships. Health professionals must monitor people with type 2 diabetes to determine the presence of Type D personality. It is particularly recommended for those with Type D personality to be provided with interventions to reduce diabetes distress and to enhance social isolation in order to improve their glycemic control and HRQOL.