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The role of coping with disease in adherence to treatment regimen and disease control in type 1 and insulin treated type 2 diabetes mellitus.

BACKGROUND
Coping is defined as the behavioral and cognitive efforts used in an attempt to deal with stressful events. The objective of this study was to explore the relationship between coping with diabetes and the following outcome variables in type 1 and insulin treated type 2 diabetes mellitus: glycemic control, microangiopathic complications, adherence to self monitoring of blood glucose, adherence to insulin injections, and adherence to diet.


METHODS
Subjects were 196 insulin treated adult diabetes patients visiting an outpatient clinic at a government university hospital in Istanbul, Turkey. Coping with disease was measured with the Turkish version of the Diabetes Coping Measure and adherence to treatment regimen was measured with a questionnaire adapted from the subscales of the Summary of Diabetes Self-Care Activities Questionnaire. Data on patients' HbA(1c) levels and severity of microangiopathic complications were obtained from their medical records.


RESULTS
Partial correlations controlling for background variables suggested that coping was a good predictor of outcome for both type 1 and insulin treated type 2 diabetes mellitus. These associations were more pronounced for type 1 patients when compared to type 2 patients. Regressing the outcome variables on the two second-order coping factors (obtained by a factor analysis) also supported the hypothesis that coping is an important construct in explaining the outcome variables. Finally, the effect of coping on HbA(1c) was only partially mediated by adherence.


CONCLUSION
Coping with diabetes-related issues is an important factor in both types of diabetes, with type 1 patients showing slightly stronger associations. Therefore, training and education programs for diabetic adults might benefit from including a component that is aimed at improving coping with issues specific to diabetes.