Illness Intrusiveness in Adults with Type 1 Diabetes: Role, Determinants, and Outcomes

Background: Adults with type 1 diabetes face many challenges in achieving their glycemic targets. These challenges can lead individuals with type 1 diabetes to feel that their disease intrudes on their life. Illness intrusiveness can negatively impact an individual’s well-being and quality of life and potential influence glucose parameters. Objective: This study was performed to investigate the relationships among treatment factors (treatment satisfaction); disease factors (disease duration), psychological factors (fear of hypoglycemia, anxiety, and depression; illness intrusiveness; and the primary outcomes of glucose parameters, including glycemic control and glycemic variability. Method: This secondary analysis employed a descriptive correlational design using pooled data from three parent studies. The sample included 74 adults (41.9% male) with type 1 diabetes (mean age 26.7 years) using insulin pump therapy. Four instruments, including the Diabetes Treatment Satisfaction Questionnaire, Hypoglycemia Fear Survey-II, Hospital Anxiety and Depression Scale, and Illness Intrusiveness Rating Scale, were used to collect participant data regarding treatment satisfaction, fear of hypoglycemia, anxiety and depression, and illness intrusiveness. Glycemic control was measured with hemoglobin A1C in the full sample of 74 participants. Glycemic variability was measured with continuous glucose monitoring technology in a subset of 21 participants. Results: Treatment satisfaction, disease duration, fear of hypoglycemia, anxiety, depression, jointly predicted 23.6% of the variance in A1C (R2 = .239, F(8,65) = 2.508, p = .019) in a model adjusted for sociodemographic characteristics. Fear of hypoglycemia had a partial indirect effect on A1C through illness intrusiveness. In terms of glycemic variability, treatment satisfaction, disease duration, FOH, anxiety, and depression jointly predicted 74.7% of the variance in illness intrusiveness (R2 = .747, F(5,15) = 8.836, p<.001). However, none of these determinants were a predictor of glycemic variability. Conclusion: The study’s findings revealed that fear of hypoglycemia had partial indirect effect on A1C through illness intrusiveness. These results will broaden healthcare providers’ understanding and perspectives regarding illness intrusiveness. Furthermore, the findings will provide foundational information for the development of interventions to reduce illness intrusiveness among adults with type 1 diabetes.