Impact of alexithymia on glycemic control among Lebanese adults with type 2 diabetes

Alexithymia, intolerance to uncertainty and mental health difficulties in adolescents with Type 1 diabetes mellitus

BACKGROUND

Type 1 Diabetes Mellitus (T1DM) represents a serious chronic condition affecting a wide number of people. Discussion of the physical issues associated with T1DM pervades the literature, however, there is less discussion of the psychological consequences. Mental health difficulties, alexithymia and uncertainty are present in this population, and known to be harmful for the onset, maintenance and worsening of T1DM. This study aimed to evaluate the presence of these phenomena in people with T1DM.

METHODS

105 participants aged between 11 and 17 years old (M: 13.88; SD: 2.16) affected by T1DM were included in the sample. To assess the presence of mental health difficulties, SAFA scales (Depression, Anxiety and Somatic symptoms) were included in the protocol together with TAS-20 and IUS-12, which evaluate the presence and role of alexithymia and intolerance to uncertainty in the sample, respectively.

RESULTS

A concerning presence of anxiety, depression and somatic symptoms was found in the sample. Mental health difficulties appeared to be consistently present in the sample, often overcoming pathological thesholds. Alexithymia and uncertainty were also common, highlighting their role in T1DM.

CONCLUSIONS

Active mental health difficulties together with high rates of alexithymia and intolerance to uncertainty were prevalent in the sample of adolescents with diabetes.

Effect of fear of hypoglycaemia on sleep quality of patients with type 2 mellitus diabetes: The mediating role of alexithymia

Background

Patients with type 2 diabetes mellitus (T2DM) commonly experience poor sleep quality. This study aimed to investigate whether alexithymia mediates the association between fear of hypoglycaemia (FoH) and sleep quality in patients with T2DM.

Methods

From September 2021 to November 2021, a cross-sectional survey was conducted on 407 patients with T2DM in China. Data collection was made possible through the administration of the Chinese Version of the Worry Scale, Toronto Alexithymia Scale and Chinese version of the Pittsburgh Sleep Quality Index (CPSQI). Multiple linear regression analyses were also performed.

Results

A total of 65.6% of the participants were male, and 75.7% were aged 18-40 years. FoH showed a moderate and positive correlation with CPSQI scores (r = 0.308, p < 0.001). Alexithymia was weakly and positively correlated with CPSQI scores (r = 0.185, p < 0.001). Meanwhile, FoH exhibited a moderate and positive correlation with alexithymia (r = 0.422, p < 0.001), and difficulty in identifying (r = 0.414, p < 0.001) and describing feelings (r = 0.416, p < 0.001) and a weak and positive correlation with externally oriented thinking (r = 0.221, p < 0.001). The total effect (β = 0.408, p < 0.001) of FoH on CPSQI comprised not only the direct (β = 0.293, 95% confidence interval: 0.174-0.411, p < 0.001) but also the indirect effect (β = 0.115, p < 0.001) of alexithymia.

Conclusions

Alexithymia can mediate the association between FoH and sleep quality. Clinicians should recognize the potential effect of alexithymia and incorporate it in intervention planning and care. Addressing the affective disturbances arising from FoH can enhance emotional expression and sleep quality among T2DM patients.

How does it feel? An exploration of neurobiological and clinical correlates of alexithymia in trauma-exposed police-officers with and without PTSD

Background: Alexithymia, an inability to recognise one's emotions, has been associated with trauma-exposure and posttraumatic stress disorder (PTSD). Previous research suggests involvement of the oxytocin system, and socio-emotional neural processes. However, the paucity of neurobiological research on alexithymia, particularly in trauma-exposed populations, warrants further investigation.Objective: Explore associations between alexithymia, endogenous oxytocin levels, and socio-emotional brain function and morphometry in a trauma-exposed sample.Method: Dutch trauma-exposed police officers with (n = 38; 18 females) and without PTSD (n = 40; 20 females) were included. Alexithymia was assessed with the Toronto Alexithymia Scale (TAS-20). Endogenous salivary oxytocin was assessed during rest, using radioimmunoassay. Amygdala and insula reactivity to socio-emotional stimuli were assessed with functional MRI, amygdala and insula grey matter volume were derived using Freesurfer.Results: Alexithymia was higher in PTSD patients compared to trauma-exposed controls (F(1,70) = 54.031, p < .001). Within PTSD patients, alexithymia was positively associated with PTSD severity (ρ(36) = 0.497, p = .002). Alexithymia was not associated with childhood trauma exposure (β = 0.076, p = .509), police work-related trauma exposure (β = -0.107, p = .355), oxytocin levels (β = -0.164, p = .161), insula (β = -0.170, p = .158) or amygdala (β = -0.175, p = .135) reactivity, or amygdala volume (β = 0.146, p = .209). Insula volume was positively associated with alexithymia (β = 0.222, p = .016), though not significant after multiple testing corrections. Bayesian analyses supported a lack of associations.Conclusions: No convincing neurobiological correlates of alexithymia were observed with any of the markers included in the current study. Yet, the current study confirmed high levels of alexithymia in PTSD patients, independent of trauma-exposure, substantiating alexithymia's relevance in the clinical phenotype of PTSD.

The prevalence and characteristics of alexithymia in patients with type 2 diabetes mellitus: A systematic review and meta-analysis

BACKGROUND

Alexithymia is common in patients with type 2 diabetes mellitus (T2DM). Although the estimated prevalence of alexithymia in patients with T2DM is widely reported, these results have not been synthesized.

AIM

To systematically assess the prevalence and characteristics of alexithymia in patients with T2DM.

METHODS

We searched for relevant publications in PubMed, Embase, Web of Science, China Knowledge Resource Integrated Database, Wanfang Database, Chinese Biomedical Database, and Weipu Database. The prevalence of alexithymia, the mean scores, and standard deviations of the total scale of the 20-item Toronto Alexithymia Scale (TAS-20) were pooled using random effects meta-analysis in Stata 13.0, with studies stratified by study location in this meta-analysis.

RESULTS

This meta-analysis included thirteen articles. Pooled prevalence of alexithymia (TAS-20 total scores ≥61) were 43.0% (95%CI 35.0-51.0%), and the prevalence of alexithymia was higher in China (45.0%, 95%CI 36.0-54.0%) compared with non-China (41.0%, 95%CI 29.0-54.0%). The pooled mean score for the TAS-20 total scale was 57.70 (95% CI 55.25-60.15). Leave-one-out analysis showed that none of the studies significantly impacted the overall pooled results.

CONCLUSIONS

This meta-analysis indicated a high prevalence of alexithymia in patients with T2DM. Thus, clinicians need to be aware of and assess appropriately for alexithymia in patients with T2DM.

Impact of Alexithymia on the Lipid Profile in Major Depressed Individuals

Background

The cooccurrence of major depression and dyslipidaemia is associated with negative cardiovascular outcome, which seems to justify a better identification of the factors favouring the development of dyslipidaemia in major depressed individuals. In the literature, there are arguments in favour of a special relationship between dyslipidaemia and alexithymia. However, despite a high prevalence of alexithymia in major depressed individuals, no study has investigated the impact of this personality trait on the lipid profile in this particular subpopulation. Given these elements, the aim of this study was therefore to investigate the risk of dyslipidaemia associated with alexithymia in major depressed individuals to allow better cardiovascular prevention in this subpopulation. Subjects and Methods. Demographic and polysomnographic data from 242 major depressed individuals recruited from the clinical database of the sleep laboratory were analysed. Only individuals with a diagnosis of dyslipidaemia according to the diagnostic criteria of the International Diabetes Federation at admission were included in the “dyslipidaemia” group. Logistic regression analyses were used to determine the risk of dyslipidaemia associated with alexithymia in major depressed individuals.

Results

The prevalence of dyslipidaemia was 43.8% in our sample of major depressed individuals. After adjusting for the main confounding factors, multivariate logistic regression analyses demonstrated that alexithymia was a risk factor for dyslipidaemia in major depressed individuals.

Conclusions

In this study, we found that alexithymia is a risk factor for dyslipidaemia in major depressed individuals, which seems to justify better identification and adequate management of this personality trait in order to allow a better lipid profile in this subpopulation at high cardiovascular risk.

Alexithymia in diabetes patients: its relationship with perceived social support and glycaemic control

AIM AND OBJECTIVE

This study was conducted to assess whether there is an association between alexithymia in patients with diabetes and the levels of perceived social support and glycaemic control.

BACKGROUND

In the literature, whether inadequate perceived social support is a cause or effect of alexithymia has also not been clearly explained. It is stated that it is difficult to determine from where these contradictions arise, and there is a need for more studies on this topic.

METHOD

This cross-sectional and correlational study included 537 patients with type I and type 2 diabetes. The data were collected using a Patient Information Form including the patient's HbA1c value that reflected their glycaemic control level, the Toronto Alexithymia Scale and the Multidimensional Scale of Perceived Social Support. The study was reported according to the STROBE Declaration.

RESULTS

Among the patients with diabetes, 63.9% showed signs of alexithymia. Alexithymia had a negative relationship with perceived social support and a positive relationship with HbA1c. Additionally, it was determined that the patients who showed signs of alexithymia had lower levels of perceived social support in comparison with those who did not show such signs, whereas the HbA1c levels of the former were also higher than those of the latter. Moreover, it was found that the duration of the disease, HbA1c levels and levels of perceived social support from family and a significant other explained 30% of the total variance in the level of alexithymia.

CONCLUSION

Alexithymia was seen prevalently among the patients with diabetes, and it was associated with a reduced level of perceived social support and weak glycaemic control.

RELEVANCE TO CLINICAL PRACTICE

It is recommended to provide patients with psychosocial support in the scope of holistic care and include the individuals who provide care for and support the patient in the patient's management of the disease.

Changes in Sexual Functions and Alexithymia Levels of Patients with Type 2 Diabetes During the COVID-19 Pandemic

This study was conducted to determine the changes in sexual functioning and alexithymia levels in patients with type 2 diabetes during the COVID-19 pandemic. This descriptive, cross-sectional study was conducted with 162 patients with type 2 diabetes. Data were collected using the Information Form, Toronto Alexithymia Scale, Hospital Anxiety and Depression Scale. For 83.3% of the participants, there was a decrease in sexual functioning after diabetes, 69.8% after the COVID-19 pandemic, and 67.2% due to both conditions. The majority of the patients stated the reasons for experiencing sexual problems related to not seeing sexuality as a priority (77.1%), and stress/anxiety experienced during the COVID-19 pandemic (67.9%). Moreover, patients' alexithymia, anxiety, and depression levels were found to be high during the pandemic, when the study was conducted. A positive correlation was identified between alexithymia and anxiety and depression. Further, multiple regression results indicated that about 50% of alexithymia levels could be explained by anxiety and depression levels. The anxiety, depression, and alexithymia scores of those who had decreased sexual functioning before and during the pandemic period were statistically significantly higher than those who did not have any change (p < 0.01). During the COVID-19 pandemic when the study was conducted, high levels of alexithymia, anxiety, and depression were observed in participants, and it was found that their sexual functioning was negatively affected. Healthcare professionals should evaluate their patients in extraordinary situations such as epidemics and pandemics in terms of sexual functioning as well as other vital functions.

The Relationship Between Alexithymia and Type 2 Diabetes: A Systematic Review

Background: This systematic review analyzed the relationship between alexithymia, considered as the inability to recognize and express thoughts and emotions, and type 2 diabetes mellitus (T2DM), one of the most common chronic illness, characterized by a metabolic disorder burdened by high morbidity and mortality worldwide due to its outcomes. Methods: PRISMA guidelines were followed throughout this systematic review of the recent literature indexed in the databases PubMed, PsycInfo, Scopus, and Web of Science. Search terms for eligible studies were: "Type 2 diabetes" OR "T2DM" AND "Toronto Alexithymia Scale" OR "TAS-20"[All Fields]. Results: The initial search identified 61 indexed scientific publications. After screening we found that seven publications met the established scientific inclusion and exclusion criteria. It emerged that alexithymic patients ranged from 25 to 50% across the examined publications and it appeared that patients with T2DM generally reflected greater values of alexithymia, revealing particular differences among TAS domains. Moreover, emlpoyed participants were alexithymic to a greater extent compared to non-working participants (77.8 vs. 35.4%) and alexithymia was 2.63 times more severe among working participants when examining predictors of alexithymia. When evaluating the correlations between alexithymia and HbA1c or fasting blood glucose levels we found strong associations equal to 0.75 and 0.77 for TAS-20 total scores, respectively. While alexithymic participants showed significantly higher levels of HbA1c and blood glucose when compared to the non-alexithymic participants. Conclusions: The results of this systematic review of the current literature highlight the need of alexithymia evaluation in patients with T2DM. The high prevalence in T2DM and strong associations with poorly regulated diabetes and psychological distress, indicate a significant relationship between poor glycemic control and psychological distress, such as anxiety and depression, and quality of life. Further studies are needed focusing on age and gender differences in order to be able to improve clinical psychological care and prevention.