The impact of clinical and psychological characteristics on alexithymia in type 1 diabetes

Basilio Pintaudi, Giacoma Di Vieste, Antonio Nicolucci, Antonio Bruno, Giovanni Genovese, Maria Rosaria Anna Muscatello, Clemente Cedro, Rocco Antonio Zoccali, Antonino Di Benedetto


Background: Alexithymia is a psychological construct characterized by inability to express emotions, poor imagination and operational thinking. It is well known its association with several chronic disease such as Diabetes type 2, little is known about diabetes type 1. We examined the association of alexithymia with clinical and psychological outcomes in subjects with type 1 diabetes.

Methods: The study was conducted in a single diabetes center. The patients fully completed a protocol composed of the following instruments: the Toronto Alexithymia Scale-20 (TAS-20), the State-Trait Anger Expression Inventory-2 (STAXI-2), the State-Trait Anxiety Inventory form Y (STAI-Y), and the Hamilton Rating Scale for Depression (HAMD). TAS-20 scores were subdivided into tertiles, Correlations and two linear regression analyses, adjusted for only clinical and clinical plus psychological characteristics, were performed. Overall, 75 patients were enrolled (mean age 41.0±11.4 years, diabetes duration 19.9±11.9 years, 49.3% males, 30.7% treated with CSII).

Results: People with diabetes of the upper TAS-20 tertile had the greatest rate of depression (with the highest degree of severity) and the higher levels of anger and anxiety. There was a significant correlation between TAS-20 scores with BMI (r=0.26; p=0.03), HAMD (r=0.38; p=0.001), STAXI-2 (r=0.34; p=0.003) and STAI-Y (r=0.48; p<0.0001).  Further regression analysis showed TAS-20 scores were associated with BMI (beta=0.29; p=0.02). The association with BMI was confirmed (beta=0.28; p=0.007) when psychological variables are considered; furthermore, a strong association with STAI-2 (beta=0.48; p<0.0001) was detected, while the analysis did reveal any significant correlation between alexithymia and HbA1c levels.

Conclusions: Alexithymia is strongly associated both with clinical and psychological characteristics, notably with BMI and anxiety traits. People with diabetes type 1 should be assessed for alexithymia. Future studies on the current topic are therefore required in order to elucidate the role of alexithymia in diabetes type 1. We believe that patients with diabetes and alexithymia could take advantage of psychological counseling.


Alexithymia; Type 1 diabetes; Psychological outcomes; BMI; Anxiety.

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