Do fatalistic attitudes affect clinical outcomes in type 2 diabetes?

University of Wisconsin-Milwaukee and University at Buffalo investigators report that diabetes fatalism is associated with lower mental health-related quality of life over 12 months in African American adults with poorly controlled type 2 diabetes. Fatalism was found to have no effect on HbA1c or blood pressure.

Diabetes affects 37.1 million adults in the US and ranks as the eighth leading cause of death, with racial disparities placing African American adults at elevated risk for complications and mortality. Previous studies have found that psychosocial factors, including fatalism, shape self-care behaviors and clinical outcomes.

In the study, “Longitudinal Effect of Diabetes Fatalism on Clinical Outcomes and Health-Related Quality of Life in African Americans with Type 2 Diabetes,” published in the Journal of General Internal Medicine, researchers investigated the longitudinal relationship between diabetes fatalism, clinical outcomes, and health-related quality of life in adults enrolled in a 12-month randomized controlled trial.

The study reportedly enrolled 200 African American adults with poorly controlled type 2 diabetes recruited from four clinical sites in the Southeast US. Participants had a mean age of 56 years and lived with diabetes for around 15 years.

Data inconsistency

For reasons that are unclear, the baseline characteristics given for the cohort could not have been generated by 200 individuals. As there are 200 individuals, characteristics represented as percentages should be whole numbers or 0.5 percentages. Instead, the study lists things like “Never Married/Single” as 24.3% and “Married” as 75.7%, which would require a minimum cohort of 1,000 individuals.

In another offering, income under $25,000 is reported as 61.03%, which would have required a minimum cohort of 10,000 individuals, not the 200 reported to be in the study.

Similar issues are revealed within one of the key metrics used in the analysis as “Emotional distress subscale scores” are stated to range from 5 to 50 in one location and 5 to 30 in another.

From many models, a few significant correlations found

In the five models presented for fatalism based on the Diabetes Fatalism Scale, no link is seen between fatalism and HbA1c, systolic blood pressure, diastolic blood pressure or a physical score for quality of life, with one statistical significance found for scoring on mental quality of life. Five more models are presented for emotional distress, a subscale of the previous fatalism survey scores. Here a slight statistical hit appears for HbA1c.

Overall, the findings seem to point to a link between fatalism and mental quality of life scores, and additional connections between emotional distress and quality of life.

With several unanswered questions about data collection and presentation errors in the published paper, it would be difficult to consider the results reliable.

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