The role of protective psychological factors, self-care behaviors, and HbA1c in young adults with type 1 diabetes

Objective To investigate whether protective psychological factors in young adults with type 1 diabetes are associated with more optimal self-care behaviors and HbA1c, and to explore possible mediators between protective psychological factors and HbA1c. Research design and methods This cross-sectional study examined the associations between protective psychological factors (optimism, positive efficacy expectancies, and self-compassion), maladaptive psychological factors (depression, anxiety, and stress), self-care behaviors, and HbA1c in 113 young adults (17-25 years) with type 1 diabetes in Auckland, New Zealand. Pearson's correlations, multiple linear regressions, and multiple mediation analyses were used to examine associations and mediators. Results Higher positive efficacy expectancies (beliefs about coping with difficulties) were associated with more optimal HbA1c (beta = -0.26, 95% CI: -1.99 to -0.45) and more optimal self-care behaviors (beta = 0.33, 95% CI: 0.28 to 0.92) in the adjusted models. Higher levels of self-compassion were associated with more optimal self-care behaviors (beta = 0.27, 95% CI: 0.09 to 0.43). Depression was associated with less optimal self-care behaviors (beta = -0.35, 95% CI: -1.33 to -0.43) and stress was associated with less optimal HbA1c (beta = 0.26, 95% CI: 0.27 to 1.21). Mediation results suggested that self-care behaviors mediated the relationship between all three of the protective psychological factors and more optimal HbA1c, and that lower stress also mediated the relationship between higher self-compassion and more optimal HbA1c. Conclusions This study adds to the emerging literature that protective psychological factors may play an adaptive role in improving health outcomes in young adults with type 1 diabetes. Interventions targeting protective psychological factors present a promising approach to optimizing wellbeing and self-care in youth with type 1 diabetes.