Advertisement

Journal of Diabetes & Metabolic Disorders

, Volume 18, Issue 1, pp 191–198 | Cite as

Impact of alexithymia on glycemic control among Lebanese adults with type 2 diabetes

  • Chirine Fares
  • Robert Bader
  • José-Noel IbrahimEmail author
Research article
  • 18 Downloads

Abstract

Purpose

Alexithymia, defined as the inability of a person to identify, describe and express emotions, has been found to influence glycemic control in type 2 diabetes patients (D2). The characteristics and influencing factors of alexithymia and the association of this psychological construct with D2 has not yet been studied in Lebanon where 14.6% of adults are diagnosed with the disease. This study aims at evaluating the prevalence of alexithymia and its relationship with glycemic control among Lebanese adults with D2.

Methods

Alexithymia was assessed in 104 patients diagnosed with D2 and 100 healthy controls using the 20-item Toronto Alexithymia Scale (TAS-20). The impact of alexithymia on glycemic control was evaluated using HbA1c values, fasting blood glucose levels, number of severe hyperglycemic episodes and hospitalizations for hyperglycemia within the past months.

Results

Alexithymia prevalence was significantly higher in D2 patients compared to controls (35.5% vs 15%). Patients with alexithymia showed higher levels of HbA1c and glucose in comparison to those without alexithymia. Consistently, significant positive correlations were found between the TAS-20 total and subscale scores and both HbA1c and glucose levels. Alexithymic patients had three times more severe hyperglycemic episodes and five times more hospitalizations for hyperglycemia compared to those without alexithymia. According to multivariate regression analysis, lifestyle factors alone were not found predictive of alexithymia in D2 patients.

Conclusion

Given the impact of alexithymia on D2 regulation, screening of alexithymia in case of D2 and appropriate psychological follow-up are important for a better prognosis, management and treatment of the disease.

Keywords

Alexithymia Type 2 diabetes Prevalence Glycemic control Lebanon 

Notes

Acknowledgments

The authors thank the students Carla Chlela and Setrida Kallass for their support, particularly in the sampling procedure.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Consent for publication

A written informed consent was obtained from all participants prior to enrollment.

Ethical approval

This study was approved by the Ethical Committee of the Lebanese German University.

References

  1. 1.
    Papatheodorou K, Banach M, Edmonds M, Papanas N, Papazoglou D. Complications of diabetes. J Diabetes Res. 2015;2015:189525.CrossRefGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2017 p. 20. Available from: https://www.cdc.gov/diabetes/data/statistics/statistics-report.html. Accessed 15 Sept 2018.
  3. 3.
    The Intenational Diabetes Federation (IDF). Members. Available from: https://www.idf.org/our-network/regions-members/middle-east-and-north-africa/members/39-lebanon.html. Accessed 15 Sept 2018.
  4. 4.
    Chen L, Pei J-H, Kuang J, Chen H-M, Chen Z, Li Z-W, et al. Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis. Metabolism. 2015;64:338–47.CrossRefGoogle Scholar
  5. 5.
    Whitworth SR, Bruce DG, Starkstein SE, Davis WA, Davis TME, Bucks RS. Lifetime depression and anxiety increase prevalent psychological symptoms and worsen glycemic control in type 2 diabetes: the Fremantle diabetes study phase II. Diabetes Res Clin Pract. 2016;122:190–7.CrossRefGoogle Scholar
  6. 6.
    Luca A, Luca M, Di Mauro M, Palermo F, Rampulla F, Calandra C. Alexithymia, more than depression, influences glycaemic control of type 2 diabetic patients. J Endocrinol Investig. 2015;38:653–60.CrossRefGoogle Scholar
  7. 7.
    Topsever P, Filiz TM, Salman S, Sengul A, Sarac E, Topalli R, et al. Alexithymia in diabetes mellitus. Scott Med J. 2006;51:15–20.CrossRefGoogle Scholar
  8. 8.
    Bastin P, Luminet O, Buysschaert M, Luts A. Contrôle du diabète et alexithymie : le rôle de l’identification et de la verbalisation des émotions. Louvain Méd. 2004;123:252.Google Scholar
  9. 9.
    Ahmadieh H, Itani H, Itani S, Sidani K, Kassem M, Farhat K, et al. Diabetes and depression in Lebanon and association with glycemic control: a cross-sectional study. Diabetes Metab Syndr Obes Targets Ther. 2018;11:717–28.CrossRefGoogle Scholar
  10. 10.
    Care CTF on PH. Recommendations on screening for type 2 diabetes in adults. CMAJ. 2012;184:1687–96.CrossRefGoogle Scholar
  11. 11.
    Bagby RM, Parker JDA, Taylor GJ. The twenty-item Toronto alexithymia scale—I. Item selection and cross-validation of the factor structure. J Psychosom Res. 1994;38:23–32.CrossRefGoogle Scholar
  12. 12.
    Parker JDA, Taylor GJ, Bagby RM. The 20-item Toronto alexithymia scale. III. Reliability and factorial validity in a community population. J Psychosom Res. 2003;55:269–75.CrossRefGoogle Scholar
  13. 13.
    Loas G, Parker JDA, Otmani O, Verrier A, Fremaux D. Confirmatory factor analysis of the French translation of the 20-item Toronto alexithymia scale. Percept Mot Skills. 1997;85:1018.CrossRefGoogle Scholar
  14. 14.
    Bondar RJ, Mead DC. Evaluation of glucose-6-phosphate dehydrogenase from Leuconostoc mesenteroides in the hexokinase method for determining glucose in serum. Clin Chem. 1974;20:586–90.Google Scholar
  15. 15.
    American Diabetes Association. Standards of medical Care in Diabetes—2015 abridged for primary care providers. Clin Diabetes Publ Am Diabetes Assoc. 2015;33:97–111.Google Scholar
  16. 16.
    Avci D, Kelleci M. Alexithymia in patients with type 2 diabetes mellitus: the role of anxiety, depression, and glycemic control. Patient Prefer Adherence. 2016;10:1271–7.CrossRefGoogle Scholar
  17. 17.
    Damak R, Mnif L, Masmoudi J, Halwani N, Mnif F, Baati I, et al. P02-299 - alexithymia in diabetes type2. Eur Psychiatry. 2010;25:1008.CrossRefGoogle Scholar
  18. 18.
    Mnif L, Damak R, Mnif F, Ouanes S, Abid M, Jaoua A, et al. Alexithymia impact on type 1 and type 2 diabetes: a case-control study. Ann Endocrinol. 2014;75:2013–9.CrossRefGoogle Scholar
  19. 19.
    Hintistan S, Cilingir D, Birinci N. Alexithymia among elderly patients with diabetes. Pak J Med Sci. 2013;29:1344–8.CrossRefGoogle Scholar
  20. 20.
    Salminen JK, Saarijärvi S, Aärelä E, Toikka T, Kauhanen J. Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland. J Psychosom Res. 1999;46:75–82.CrossRefGoogle Scholar
  21. 21.
    Stingl M, Naundorf K, vom Felde L, Bernd H. Alexithymia in type I and type II diabetes. Interv Obes Diabetes. 2018;1:1–4.Google Scholar
  22. 22.
    Levant RF, Hall RJ, Williams CM, Hasan NT. Gender differences in alexithymia. Psychol Men Masculinity. 2009;10:190–203.CrossRefGoogle Scholar
  23. 23.
    Abramson L, McClelland DC, Brown D, Kelner S. Alexithymic characteristics and metabolic control in diabetic and healthy adults. J Nerv Ment Dis. 1991;179:490–4.CrossRefGoogle Scholar
  24. 24.
    Contreras CM, Gutiérrez-García AG. Cognitive impairment in diabetes and poor glucose utilization in the intracellular neural milieu. Med Hypotheses. 2017;104:160–5.CrossRefGoogle Scholar
  25. 25.
    Jones DT. Neural networks, cognition, and diabetes: what is the connection? Diabetes. 2012;61:1653–5.CrossRefGoogle Scholar
  26. 26.
    Morie KP, Yip SW, Nich C, Hunkele K, Carroll KM, Potenza MN. Alexithymia and addiction: a review and preliminary data suggesting neurobiological links to reward/loss processing. Curr Addict Rep. 2016;3:239–48.CrossRefGoogle Scholar
  27. 27.
    Misterska E, Glowacki M, Adamczyk K, Glowacki J, Harasymczuk J. A longitudinal study of alexithymia in relation to physical activity in adolescent females with scoliosis subjected to cheneau brace treatment: preliminary report. Spine. 2014;39:E1026–34.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Faculty of Public HealthLebanese German University (LGU)KeserwanLebanon
  2. 2.Faculty of MedicineSaint-Joseph University (USJ)BeirutLebanon
  3. 3.Faculty of Public Health IILebanese UniversityFanarLebanon

Personalised recommendations