Abstract

OBJECTIVE—Research suggests that increased collaboration and satisfaction in the patient-provider relationship is associated with better outcomes in patients with diabetes. In adults, an interpersonal style characterized by low trust of others and excessive self-reliance is known as “dismissing attachment style.” We hypothesized that diabetic patients with dismissing attachment style, due to a decreased ability to collaborate with providers and others, would have significantly higher HbA_1c levels than patients with secure attachment style.

RESEARCH DESIGN AND METHODS—From 276 adult tertiary care patients with type 1 diabetes, we obtained mean HbA_1c levels over the prior year and assessed patient attachment style, demographics, and clinical characteristics. We used χ² tests and logistic regression to determine whether attachment style was associated with HbA_1c levels.

RESULTS—We found that 62% of patients with dismissing attachment style had mean HbA_1c levels ≥8% compared with 34% of patients with secure attachment style (P = 0.002). After adjusting for demographics, diabetes severity, medical comorbidity, and depression, dismissing attachment style remained significantly associated with HbA_1c levels ≥8%, compared with secure attachment style (odds ratio 2.5, 95% CI 1.1–6.0).

CONCLUSIONS—We have found that dismissing attachment style is associated with a higher risk for poor glycemic control. This has relevance from a population-based perspective because ∼25% of the general population has a dismissing attachment style. Attachment style is easily measured using self-report instruments and may inform clinicians how to work with patients who are less engaged in the health care relationship.