Can Personality Predict Development of Diabetes?

Comments by lead author Iva Čukić, PhD and Deena Adimoolam, MD

Word Diabetes made of wooden block letters and devastated middle aged manThe personality traits of Neuroticism, Openness, Activity, Impulsiveness, and Order were related to diagnosis of diabetes in a large observational study published in the February issue of Personality and Individual Differences. The relationship between these traits and diabetes were mediated by body mass index (BMI), alcohol intake, physical activity, and dietary habits.

“Individual variations in personality traits have proven to be reliable and stable across time,” explained lead author Iva Čukić, PhD, Postdoctoral Researcher at the Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Scotland. “Understanding how they relate to disease onset and management is of paramount importance in devising successful prevention and intervention strategies, and ultimately, minimizing each person’s potential to develop a disease, and maximizing success in treating a disease if the person happens to develop it.”

“There are two main areas where understanding how personality relates to diabetes can be useful in a clinical setting,” Dr. Čukić said. “First, personality traits can help identify individuals who are at risk of developing diabetes early, and engage them in prevention strategies. Second, personality traits may relate to whether people are successful in managing symptoms of diabetes, so practitioners could identify those at risk of poorer management and spend more time educating them on treatment.”

“This study shines light on a new way of understanding personality and how it relates to diagnosis of diabetes,” commented Deena Adimoolam, MD, Assistant Professor of Diabetes, Endocrinology and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY.

Large National Sample From Estonia
The authors examined self-report and informant-completed personality questionnaires from 3,592 people (ages 18-91 years, mean age, 43.2 years) in the Estonian Biobank cohort, a large volunteer-based sample of the Estonian resident adult population. A combined measure of type 1 and type 2 diabetes was used to maximize power in this analysis.

The authors assessed the Big Five traits in psychology—neuroticism, openness, extroversion, agreeableness, and conscientiousness—and found that only neuroticism and openness on patient self-report were associated with diabetes diagnosis (Table; P<0.05). On self-report, the following facets of the Big Five traits were predictive of diabetes diagnosis: Activity, Impulsiveness, Order, and Values. Analysis of informant-ratings showed that Activity, Gregariousness, Impulsiveness, and Order were associated with diabetes diagnosis.
Table. Personality Domains and Facets Associated With Diabetes DiagnosisBMI was the strongest mediator of the link between personality and diabetes association, explaining 30%–50% of the observed associations. Other mediators of this association included alcohol, physical activity, and diet.

How Is Neuroticism Associated With Diabetes?
“Higher neuroticism has been linked with several negative health outcomes; however, the exact mechanisms of this association are still unknown,” Dr. Čukić explained. “In fact, there are some studies that showed that higher neuroticism could lead to a lower risk of developing diabetes, and better blood glucose management later on. However, our current study suggests that higher neuroticism may be linked to higher BMI, and subsequently with diabetes, perhaps because some neurotic people may use overeating as one of the maladaptive coping strategies.”

“Similarly, lower openness has been associated with negative health outcomes, and reasons for that may be that it is typically related to lower intelligence, which in turn is often related with lower socioeconomic status and thus poorer health outcomes,” Dr. Čukić said. “More research is needed before we understand these mechanisms fully.”

How Are the Facets of Order and Values Linked to Diabetes?
“Order is a facet of a personality trait that we call Conscientiousness, which reflects the extent to which a person is organized and keeps their possessions in order versus having a messy environment,” Dr. Čukić said. “This is not to say that becoming more organized can reduce one’s risk of diabetes, although it may be the case, too. It can be that people who are naturally more organized also are more organized in other aspects of life, such as having regular meals and an exercise regime. Again, more research is needed before we understand these mechanisms.”

“Values is a facet of Openness, which reflects the extent to which a person is accepting of new ideas, open to considering various political and social views and so on, versus being rigid in their thinking,” Dr. Čukić said. “Speculatively, being high on Openness to Values may allow people to be accepting on and try out various health or nutritional regimes, like experimenting with new diets and exercise programs, versus following a traditional diet without willingness to change.”

Potential Clinical Implications of the Findings
As clinicians, we routinely assess the personality traits of our patients by just talking with them; generally, there is no need for formal personality testing,” Dr. Adimoolam commented. “I think personality testing might be helpful if the provider is unable to understand a patient’s personality or behaviors and how it links to their diabetes diagnosis and treatment. It is important to recognize a patient’s personality traits to know how to best interact with them at each visit and to understand their actions and how they relate to diabetes management. Understanding certain personality traits—like openness—may help us understand a patient’s willingness to try new therapies or lifestyle changes.”

Dr. Adimoolam added that “Diabetes management needs to be individualized based on patient’s preferences, personality, and co-morbidities. Not every patient needs to achieve a goal hemoglobin A1C of less than 7!”

Strengths and Limitations of the Trial
“A strength of this trial is that it explored multiple personality domains and facets in looking for associations with diabetes,” Dr. Adimoolam said. “One weakness is that the information is not generalizable. This study specifically looked at Estonians—a group of people whose culture and behaviors might be quite different from Americans.”

“Another weakness is that this study looked at patients with type 1 and type 2 diabetes collectively,” Dr. Adimoolam said. “Most diabetes specialists will agree that there is a difference in behaviors/personalities between patients with type 1 and type 2 diabetes due to age of onset (younger in type 1), physiology, etc. Thus, these patients are at times managed very differently. It would be helpful to evaluate the data in each group separately.”

A Call For More Research
“Individual variations in personality traits have proven to be reliable and stable across time,” Dr. Čukić said. “Understanding how they relate to disease onset and management is of paramount importance in devising successful prevention and intervention strategies, and ultimately, minimizing each person’s potential to develop a disease, and maximizing success in treating a disease if the person happens to develop it.”

Dr. Čukić emphasized that no one study is definitive, and that these findings need to be replicated multiple times before any strong claims can be made.

March 4, 2016

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