p, sychological and Social Correlates of Glycemic Control ROGER S. MAZZE, Ph.D., DAVID LUCIDO, Ph.D., AND HARRY SHAMOON, M.D. Eighty-four persons with insulin-dependent diabetes participated in this study to determine whether glycemic control was related to personality, anxiety, depression, and/or quality of life. The subjects were placed on either a conventional treatment regimen consisting of one to two injections of mixed short- and intermediate-acting insulin, with urine testing or an intensive treatment regimen consisting of two or more injections of mixed insulins, with self-monitoring of blood glucose. Personality was found to have no relationship to level of glycemic control either at the beginning of the study or at any point during the study. In contrast, anxiety, depression, and quality of life showed a significant relationship to metabolic control at entry and throughout the study period. Lower anxiety and depression scores and better quality of life scores were recorded for those subjects in good control (HbA! < 8.9%) when compared with those in average control (HbAj 9.0-11.9%) and those in poor control (HbA! > U-9%) at entry (P = 0.01). At each point during the study the difference between those in good control and those in poor control in terms of anxiety, depression, and quality of life was significant (P = 0.02). Change in glycemic control was found to account for up to 20% of the between- patient variability for these psychosocial parameters, DIABETES CARE 1984; 7:360-66. D iabetes, like other chronic diseases, may have a major impact on the individual's psychosocial status. 1 " 6 Unlike other chronic diseases, how- ever, the extraordinary effort required for self- care as well as the ever-present possibility of developing com- plications may present added psychological and social stresses that would adversely affect the person with diabetes. Previous studies, which have examined the effect of diabetes on psy- chological and social characteristics, are divided as to whether persons with diabetes differ significantly from persons without diabetes. 7 Few studies have attempted to evaluate the rela- tionship between psychosocial factors and glycemic control, due largely to the absence of adequate measurements of long- term metabolic control. While earlier studies have examined the psychological changes that may occur with and following the diagnosis of diabetes 8 " 10 as well as the psychological dif- ferences between persons with diabetes and persons without diabetes, u " 13 few investigators 14 have examined such dynamic psychosocial characteristics as quality of life, depression, and anxiety as they relate to glycemic control. These latter issues are of particular concern in view of the current interest in more stringent metabolic control and the prevention of com- plications. 1516 We therefore set out to examine: (1) whether there are psychological and social characteristics unique to persons with insulin-dependent diabetes mellitus (IDDM); (2) whether such characteristics are related to the degree of glycemic control; and (3) whether different treatment ap- proaches are associated with changes in these psychosocial variables. MATERIALS AND METHODS Subjects. One hundred fifteen individuals with IDDM re- sponded to advertisements in local and regional newspapers. Telephone screening for age (13-41 yr), absence of debili- tating complications, no current pregnancy, and accessibility to the diabetes study site reduced the initial subject pool to 84. This subject pool consisted of 59 women and 25 men with an average age of 26.9 yr (±0.8), and an average du- ration of diabetes of 11.1 yr (±0.9). This predominantly urban population (70%) was 60% Caucasian, 22% black, and 18% Hispanic. Fifty-five percent of the subjects were employed, 15% were unemployed, 12% were homemakers, and 18% were attending school. The study group was com- 360 DIABETES CARE, VOL. 7 NO. 4, JULY-AUGUST 1984