WITHDRAWN - Could Improved Health Locus of Control Prevent Type 2 Diabetes?
Type 2 diabetes is a common condition mostly treated in primary care. In order to prevent development of type 2 diabetes, it is crucial to gain a greater understanding of psychological factors that affect lifestyle behavior and how lifestyle behaviors could be modified. Perceived ability to modify one’s behavior, Health Locus of Control (HLoC), may be an aspect to consider in preventive interventions. We therefore aimed to longitudinally assess the hypothesis that low HLoC is associated with the development of type 2 diabetes in a Swedish population.
In 2002-2005, a random sample of 2816 men and women aged 30-74 years participated (76%) in a survey in two municipalities in southwestern Sweden. Participants performed an OGTT, had anthropometric measurements taken and answered questionnaires about e.g. educational level, smoking, and leisure time physical activity. HLoC was measured with the question ‘‘Do you believe that you can do anything yourself in order to preserve good health?”. A follow-up visit was conducted between 2011 and 2014, repeating the protocol from the baseline survey, with some additions. The visit included 1334 individuals (participation rate 73%). For the present study, 1268 subjects without known diabetes prior to baseline were included.
During follow-up (mean 9.7 years), 4.7% (n=30) of the women and 7.4% (n=46) of the men developed type 2 diabetes. Among them, 40% (n=12) of the women and 26% (n=12) of the men reported low HLoC at baseline. In comparison, 19% (n=123) of the women and 23% (n=143) of the men in the entire study population reported low HLoC at baseline.
Logistic regression analysis showed an age-adjusted association between low HLoC at baseline and development of type 2 diabetes during follow-up in women (OR 2.7, 95% CI: 1.2-6.1), but not in men (OR 1.1, 95% CI: 0.6-2.3). The association in women remained when adjusting also for educational level, smoking, and BMI (OR 2.4, 95% CI: 1.03-5.7), but was no longer statistically significant when adding physical activity to the model (OR 2.0, 95% CI: 0.8-4.7).
These findings highlight the importance of psychological orientation towards efforts to modify lifestyle behaviors in order to prevent type 2 diabetes, at least in women. While physical activity seems to be an important factor in the causal pathway between HLoC and development of diabetes, more studies are needed to understand the implications of these findings.