DAILY self-management behaviours may influence both glycaemic control and psychological wellbeing among adults with Type 1 diabetes, according to a study examining the relationship between diabetes care routines, distress, and psychological flexibility.
Researchers found that more frequent glucose monitoring and insulin administration were associated with lower glycated haemoglobin (HbA1c), while greater psychological flexibility and perceived achievement of self-care goals were linked to both improved glycaemic outcomes and lower diabetes-related distress.
Living with Type 1 diabetes requires multiple daily decisions, including checking glucose concentrations, administering insulin, managing meals, and preparing for hypoglycaemia.
However, maintaining these behaviours can place a considerable psychological burden on patients, potentially affecting both wellbeing and diabetes management.
Researchers conducted a cross-sectional study involving 105 adults with Type 1 diabetes attending a tertiary diabetes outpatient clinic.
Participants completed questionnaires during routine appointments, reporting the frequency of their self-care behaviours alongside measures of diabetes distress and psychological flexibility.
Psychological flexibility refers to an individual’s ability to adapt their behaviour in response to changing circumstances while remaining focused on personally meaningful goals.
The researchers examined associations between these measures, HbA1c, and psychological distress to identify behaviours that could potentially be targeted through personalised interventions.
Approximately half of participants reported performing certain important self-care behaviours less frequently than generally considered necessary for managing day-to-day glucose variations.
HbA1c below 64 mmol/mol (8%) was associated with several behaviours, including more frequent glucose checks and insulin administration.
Participants with HbA1c below this threshold also reported omitting mealtime insulin less frequently and having food available to treat hypoglycaemia on more days.
These findings suggest that relatively specific, measurable daily behaviours may provide useful information about glycaemic management.
Rather than focusing exclusively on overall treatment adherence, the researchers propose that identifying individual self-care patterns could help clinicians recognise practical areas where patients may benefit from additional support.
Clinically significant diabetes distress was associated with less frequent insulin administration and fewer glucose checks before administering insulin.
Higher perceived achievement of diabetes self-care goals and greater psychological flexibility were associated with both lower HbA1c and reduced distress.
The findings highlight the potential value of incorporating psychological wellbeing into routine diabetes consultations alongside conventional clinical measurements.
A brief, point-of-care questionnaire could help clinicians identify behaviours associated with poorer outcomes and guide more personalised discussions about self-management.
However, the study’s cross-sectional design means it cannot determine whether self-care behaviours or psychological flexibility directly cause improvements in glycaemic control or distress.
The researchers therefore recommend prospective studies to establish whether routinely collecting behavioural information can improve personalised diabetes care and longer-term health outcomes.
Reference
Nicholas JA et al. Frequency of Key Type 1 Diabetes Self-Care Behaviours Are Associated With Psychological Flexibility, Distress and Glycaemic Outcome. Endocrinol Diabetes Metab. 2026;9(5):e70336. doi:10.1002/edm2.70336.
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