When diabetics dismiss their treatment.

Some people with diabetes who dislike their physicians--or feel unable to talk openly with them--have difficulty injecting themselves daily with insulin, avoiding sugar-laden foods, and following through on other unpleasant but lifesaving treatments. Among these patients, those who generally avoid close relationships and exalt self-reliance exhibit particular difficulty in heeding the physician's directions and controlling their blood sugar concentrations, a new study finds.

Physicians need to focus on how best to deal with people with diabetes who display this "dismissive" approach to human interactions, say psychiatrist Paul S. Ciechanowski of the University of Washington in Seattle and his colleagues.

In contrast, self-treatment proceeds much more smoothly for diabetic patients who are preoccupied with getting others' approval in close relationships, who desire social contact but avoid it for fear of rejection, or who are generally secure with intimate contacts, the researchers report in the January AMERICAN JOURNAL OF PSYCHIATRY.

Ceichanowski's group explored links between diabetic patients' participation in medical treatment and their so-called attachment styles. Attachment theory holds that early experiences with caregivers cause individuals to form ingrained assumptions about whether they're worthy of care and whether others can be trusted to provide it (SN: 7/1/00, p. 8).

The researchers recruited 367 health maintenance organization patients with type I or type II diabetes. Each participant had visited the same primary-care physician at least three times in the past 2 years. Medical files provided data on diabetic patients' blood-glucose control and their consistency in taking medications and keeping clinic appointments. The participants, most of whom were white and well educated, also completed questionnaires on the quality of communication with their physician, their diabetes self-care activities, and attitudes toward personal relationships.

Among the 78 patients with a dismissive attachment style, blood-glucose concentrations were markedly higher for those who reported poor communication with their physician than for the others. The same people proved less able to monitor their glucose concentrations and keep their clinic appointments.

For the remaining patients, who had a preoccupied, fearful, or secure attachment style, poor communication with their physician didn't increase their problems in maintaining blood-glucose concentrations or adhering to the recommended diabetes treatment.

--B.B.