Examining Indirect Effects of Anxiety on Glycated Hemoglobin via Automatic Negative Thinking and Diabetes-Specific Distress in Adolescents With Type 1 Diabetes

Abstract

Objectives: In this study, we examined the indirect effects of anxiety on glycated hemoglobin (A1C) via automatic negative thinking and diabetes distress among adolescents with type 1 diabetes (T1D) during the follow-up interval of a randomized controlled trial of an intervention targeting resilience promotion/depression prevention.

Methods: Adolescents (N=264) participating in the Supporting Teen Problem Solving clinical trial were included and assessed at 8, 12, 16 and 28 months postbaseline. A serial, double-mediation model was used to examine path effects from anxiety to A1C through automatic negative thinking, through diabetes distress and through both automatic negative thinking and diabetes distress. Relevant demographic and clinical covariates were included.

Results: Anxiety significantly predicted increases in both automatic negative thinking and diabetes distress. Automatic negative thinking was not found to mediate the association between anxiety and A1C, but diabetes distress did mediate the association. The double-mediation path through automatic negative thinking and diabetes distress together was significant. The indirect effect of anxiety on A1C through diabetes distress was significant and greater than the indirect effect of the double-mediator path. Anxiety did not predict A1C independent of its effects on automatic negative thinking and diabetes distress. Inclusion of demographic covariates did not substantively change the results.

Conclusions: Analyses suggest that automatic negative thinking and diabetes distress mediate the relationship between anxiety and A1C among adolescents with T1D. Diabetes distress appears to be a robust factor linking anxiety to A1C. Diabetes distress should be further examined as a mediator of glycemic variability in anxious youth with T1D.

Keywords: A1C; A1c; adolescents; automatic negative thinking; diabetes distress; diabète de type 1; détresse liée au diabète; mediator; médiateur; pensées automatiques négatives; type 1 diabetes.

Figure 1:

Schematic diagram of proposed mediation model. Indirect effects of anxiety on A1c are being modeled through a double, serial mediation path (path effect abc) in addition to single mediation paths through automatic negative thinking (path effect ae) and diabetes distress (path effect dc). Follow-up assessment refers to the number of months following baseline assessment in the larger study from which data originate. Measures associated with constructs appear in parentheses. STAI=State-Trait Anxiety Inventory; ATQ=Automatic Thoughts Questionnaire; PAID-T=Problem Areas in Diabetes, Teen Self-report.