Current Diabetes Reports

, Volume 13, Issue 6, pp 917–929 | Cite as

Positive Psychological Characteristics in Diabetes: A Review

  • Christopher M. CelanoEmail author
  • Eleanor E. Beale
  • Shannon V. Moore
  • Deborah J. Wexler
  • Jeff C. Huffman
Psychosocial Aspects (KK Hood, Section Editor)


Positive psychological characteristics, such as optimism, self-efficacy, and resilience, have been increasingly associated with improved outcomes in medically ill individuals. However, there has been minimal systematic review of these characteristics and their associations with outcomes in people with diabetes. We aim to review these associations, their potential mediating mechanisms, and the evidence supporting interventions targeting these qualities. In people with diabetes, positive psychological characteristics are significantly associated with improved glycemic control, fewer complications, and reduced rates of mortality. Potential mechanisms mediating these associations include behavioral factors (e.g., improved treatment adherence), reduced inflammation, and improved neuroendocrine and autonomic functioning. Most psychosocial treatments in this population have focused on improving self-efficacy and resilience; such interventions may improve quality of life, well-being, and diabetes self-care. While untested in diabetes, interventions to boost other positive characteristics have been effective in other medically ill patients and may warrant further study in this cohort.


Diabetes Positive affect Well-being Self-efficacy Optimism Resilience Positive psychological characteristics 



Christopher M. Celano was provided a Dupont-Warren Fellowship to study positive psychological interventions in patients in the depressed phase of bipolar disorder from Harvard Medical School. Jeff C. Huffman has received grant funding for positive psychology research in cardiac patients from NIH/NHLBI.

Compliance with Ethics Guidelines

Conflict of Interest

Christopher M. Celano, Eleanor Beale, Shannon Moore, Deborah J. Wexler, and Jeff C. Huffman declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, GA. 2011. Accessed 05/21/2013; 2013.Google Scholar
  2. 2.
    Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24(6):1069–78.PubMedCrossRefGoogle Scholar
  3. 3.
    Li C, Barker L, Ford ES, et al. Diabetes and anxiety in US adults: findings from the 2006 Behavioral Risk Factor Surveillance System. Diabet Med. 2008;25(7):878–81.PubMedCrossRefGoogle Scholar
  4. 4.
    Niemcryk SJ, Speers MA, Travis LB, Gary HE. Psychosocial correlates of hemoglobin Alc in young adults with type I diabetes. J Psychosom Res. 1990;34(6):617–27.PubMedCrossRefGoogle Scholar
  5. 5.
    Lustman PJ, Clouse RE. Depression in diabetic patients: the relationship between mood and glycemic control. J Diabet Complicat. 2005;19(2):113–22.Google Scholar
  6. 6.
    Egede LE. Diabetes, major depression, and functional disability among U.S. adults. Diabetes Care. 2004;27(2):421–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Egede LE, Zheng D, Simpson K. Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care. 2002;25(3):464–70.PubMedCrossRefGoogle Scholar
  8. 8.
    Egede LE, Nietert PJ, Zheng D. Depression and all-cause and coronary heart disease mortality among adults with and without diabetes. Diabetes Care. 2005;28(6):1339–45.PubMedCrossRefGoogle Scholar
  9. 9.
    Zhang X, Norris SL, Gregg EW, et al. Depressive symptoms and mortality among persons with and without diabetes. Am J Epidemiol. 2005;161(7):652–60.PubMedCrossRefGoogle Scholar
  10. 10.
    Chida Y, Steptoe A. Positive psychological well-being and mortality: a quantitative review of prospective observational studies. Psychosom Med. 2008;70(7):741–56.PubMedCrossRefGoogle Scholar
  11. 11.
    Moskowitz JT, Epel ES, Acree M. Positive affect uniquely predicts lower risk of mortality in people with diabetes. Health Psychol. 2008;27(1 Suppl):S73–82.PubMedCrossRefGoogle Scholar
  12. 12.
    Ciechanowski PS, Katon WJ, Russo JE, Hirsch IB. The relationship of depressive symptoms to symptom reporting, self-care and glucose control in diabetes. Gen Hosp Psychiatry. 2003;25(4):246–52.PubMedCrossRefGoogle Scholar
  13. 13.
    Musselman DL, Betan E, Larsen H, Phillips LS. Relationship of depression to diabetes types 1 and 2: epidemiology, biology, and treatment. Biol Psychiatry. 2003;54(3):317–29.PubMedCrossRefGoogle Scholar
  14. 14.
    Melin EO, Thunander M, Svensson R, et al. Depression, obesity, and smoking were independently associated with inadequate glycemic control in patients with type 1 diabetes. Eur J Endocrinol. 2013;168(6):861–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Black SA, Markides KS, Ray LA. Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care. 2003;26(10):2822–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Scherrer JF, Garfield LD, Chrusciel T, et al. Increased risk of myocardial infarction in depressed patients with type 2 diabetes. Diabetes Care. 2011;34(8):1729–34.PubMedCrossRefGoogle Scholar
  17. 17.
    • van Dooren FE, Nefs G, Schram MT, et al. Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis. PLoS One. 2013;8(3):e57058. This is a systematic review and meta-analysis of 16 studies involving 21,443 DM patients with comorbid depression, which found that depression is associated with a nearly 1.5-fold increased risk of all-cause mortality in DM.PubMedCrossRefGoogle Scholar
  18. 18.
    Park M, Katon WJ, Wolf FM. Depression and risk of mortality in individuals with diabetes: a meta-analysis and systematic review. Gen Hosp Psychiatry. 2013;35(3):217–25.PubMedCrossRefGoogle Scholar
  19. 19.
    Katon WJ, Lin EH, Von Korff M, et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med. 2010;363(27):2611–20.PubMedCrossRefGoogle Scholar
  20. 20.
    Hermanns N, Caputo S, Dzida G, et al. Screening, evaluation and management of depression in people with diabetes in primary care. Prim Care Diabetes. 2013;7(1):1–10.PubMedCrossRefGoogle Scholar
  21. 21.
    Papanas N, Tsapas A, Papatheodorou K, et al. Glycaemic control is correlated with well-being index (WHO-5) in subjects with type 2 diabetes. Exp Clin Endocrinol Diabetes. 2010;118(6):364–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Tsenkova VK, Love GD, Singer BH, Ryff CD. Socioeconomic status and psychological well-being predict cross-time change in glycosylated hemoglobin in older women without diabetes. Psychosom Med. 2007;69(8):777–84.PubMedCrossRefGoogle Scholar
  23. 23.
    Van der Does FE, De Neeling JN, Snoek FJ, et al. Symptoms and well-being in relation to glycemic control in type II diabetes. Diabetes Care. 1996;19(3):204–10.PubMedCrossRefGoogle Scholar
  24. 24.
    Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1):1–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215.PubMedCrossRefGoogle Scholar
  26. 26.
    Venkataraman K, Kannan AT, Kalra OP, et al. Diabetes self-efficacy strongly influences actual control of diabetes in patients attending a tertiary hospital in India. J Community Health. 2012;37(3):653–62.PubMedCrossRefGoogle Scholar
  27. 27.
    Sacco WP, Bykowski CA. Depression and hemoglobin A1c in type 1 and type 2 diabetes: the role of self-efficacy. Diabetes Res Clin Pract. 2010;90(2):141–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Al-Khawaldeh OA, Al-Hassan MA, Froelicher ES. Self-efficacy, self-management, and glycemic control in adults with type 2 diabetes mellitus. J Diabet Complicat. 2012;26(1):10–6.CrossRefGoogle Scholar
  29. 29.
    Ikeda K, Aoki H, Saito K, et al. Associations of blood glucose control with self-efficacy and rated anxiety/depression in type II diabetes mellitus patients. Psychol Rep. 2003;92(2):540–4.PubMedCrossRefGoogle Scholar
  30. 30.
    Chih AH, Jan CF, Shu SG, Lue BH. Self-efficacy affects blood sugar control among adolescents with type I diabetes mellitus. J Formos Med Assoc. 2010;109(7):503–10.PubMedCrossRefGoogle Scholar
  31. 31.
    Johnston-Brooks CH, Lewis MA, Garg S. Self-efficacy impacts self-care and HbA1c in young adults with Type I diabetes. Psychosom Med. 2002;64(1):43–51.PubMedGoogle Scholar
  32. 32.
    Rose M, Fliege H, Hildebrandt M, et al. The network of psychological variables in patients with diabetes and their importance for quality of life and metabolic control. Diabetes Care. 2002;25(1):35–42.PubMedCrossRefGoogle Scholar
  33. 33.
    DeNisco S. Exploring the relationship between resilience and diabetes outcomes in African Americans. J Am Acad Nurse Pract. 2011;23(11):602–10.PubMedCrossRefGoogle Scholar
  34. 34.
    Yi JP, Vitaliano PP, Smith RE, et al. The role of resilience on psychological adjustment and physical health in patients with diabetes. Br J Health Psychol. 2008;13(Pt 2):311–25.PubMedCrossRefGoogle Scholar
  35. 35.
    de Groot M, Anderson R, Freedland KE, et al. Association of depression and diabetes complications: a meta-analysis. Psychosom Med. 2001;63(4):619–30.PubMedGoogle Scholar
  36. 36.
    Saatci E, Tahmiscioglu G, Bozdemir N, et al. The well-being and treatment satisfaction of diabetic patients in primary care. Health Qual Life Outcome. 2010;8:67.CrossRefGoogle Scholar
  37. 37.
    Davidson KW, Mostofsky E, Whang W. Don't worry, be happy: positive affect and reduced 10-year incident coronary heart disease: the Canadian Nova Scotia Health Survey. Eur Heart J. 2010;31(9):1065–70.PubMedCrossRefGoogle Scholar
  38. 38.
    •• Rasmussen HN, Scheier MF, Greenhouse JB. Optimism and physical health: a meta-analytic review. Ann Behav Med. 2009;37(3):239–56. This meta-analysis of 83 studies (including several in DM patients) found that optimism was significantly associated with improved physical health outcomes (effect size = 0.17), including mortality.PubMedCrossRefGoogle Scholar
  39. 39.
    • Tindle HA, Chang YF, Kuller LH, et al. Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women's Health Initiative. Circulation. 2009;120(8):656–62. This is one of the largest (N = 95,253 women) cohort studies supporting the prospective association between optimism and health outcomes. Specifically, optimism was prospectively associated with a decreased risk of incident coronary heart disease and reduced rates of mortality, independently of cynical hostility.PubMedCrossRefGoogle Scholar
  40. 40.
    Jyotsna VP, Sahoo A, Sreenivas V, Deepak KK. Prevalence and pattern of cardiac autonomic dysfunction in newly detected type 2 diabetes mellitus. Diabetes Res Clin Pract. 2009;83(1):83–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Jaiswal M, Urbina EM, Wadwa RP, et al. Reduced heart rate variability among youth with type 1 diabetes: the SEARCH CVD study. Diabetes Care. 2013;36(1):157–62.PubMedCrossRefGoogle Scholar
  42. 42.
    Cho YH, Craig ME, Srinivasan S, et al. Heart rate variability in pubertal girls with type 1 diabetes: its relationship with glycaemic control, insulin resistance and hyperandrogenism. Clin Endocrinol (Oxf). 2013.Google Scholar
  43. 43.
    Thayer JF, Yamamoto SS, Brosschot JF. The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int J Cardiol. 2010;141(2):122–31.PubMedCrossRefGoogle Scholar
  44. 44.
    Orlov S, Bril V, Orszag A, Perkins BA. Heart rate variability and sensorimotor polyneuropathy in type 1 diabetes. Diabetes Care. 2012;35(4):809–16.PubMedCrossRefGoogle Scholar
  45. 45.
    Licht CM, de Geus EJ, Penninx BW. Dysregulation of the autonomic nervous system predicts the development of the metabolic syndrome. J Clin Endocrinol Metab. 2013.Google Scholar
  46. 46.
    Reichard P, Pihl M. Mortality and treatment side-effects during long-term intensified conventional insulin treatment in the Stockholm Diabetes Intervention Study. Diabetes. 1994;43(2):313–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Zola B, Kahn JK, Juni JE, Vinik AI. Abnormal cardiac function in diabetic patients with autonomic neuropathy in the absence of ischemic heart disease. J Clin Endocrinol Metab. 1986;63(1):208–14.PubMedCrossRefGoogle Scholar
  48. 48.
    Liao D, Carnethon M, Evans GW, et al. Lower heart rate variability is associated with the development of coronary heart disease in individuals with diabetes: the atherosclerosis risk in communities (ARIC) study. Diabetes. 2002;51(12):3524–31.PubMedCrossRefGoogle Scholar
  49. 49.
    Steptoe A, Gibson EL, Hamer M, Wardle J. Neuroendocrine and cardiovascular correlates of positive affect measured by ecological momentary assessment and by questionnaire. Psychoneuroendocrinology. 2007;32(1):56–64.PubMedCrossRefGoogle Scholar
  50. 50.
    Brummett BH, Boyle SH, Kuhn CM, et al. Positive affect is associated with cardiovascular reactivity, norepinephrine level, and morning rise in salivary cortisol. Psychophysiology. 2009;46(4):862–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Bostock S, Hamer M, Wawrzyniak AJ, et al. Positive emotional style and subjective, cardiovascular and cortisol responses to acute laboratory stress. Psychoneuroendocrinology. 2011;36(8):1175–83.PubMedCrossRefGoogle Scholar
  52. 52.
    Bhattacharyya MR, Whitehead DL, Rakhit R, Steptoe A. Depressed mood, positive affect, and heart rate variability in patients with suspected coronary artery disease. Psychosom Med. 2008;70(9):1020–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Kop WJ, Synowski SJ, Newell ME, et al. Autonomic nervous system reactivity to positive and negative mood induction: the role of acute psychological responses and frontal electrocortical activity. Biol Psychol. 2011;86(3):230–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Oveis C, Cohen AB, Gruber J, et al. Resting respiratory sinus arrhythmia is associated with tonic positive emotionality. Emotion. 2009;9(2):265–70.PubMedCrossRefGoogle Scholar
  55. 55.
    Kok BE, Fredrickson BL. Upward spirals of the heart: autonomic flexibility, as indexed by vagal tone, reciprocally and prospectively predicts positive emotions and social connectedness. Biol Psychol. 2010;85(3):432–6.PubMedCrossRefGoogle Scholar
  56. 56.
    Forbes JM, Cooper ME. Mechanisms of diabetic complications. Physiol Rev. 2013;93(1):137–88.PubMedCrossRefGoogle Scholar
  57. 57.
    Lechleitner M, Koch T, Herold M, et al. Tumour necrosis factor-alpha plasma level in patients with type 1 diabetes mellitus and its association with glycaemic control and cardiovascular risk factors. J Intern Med. 2000;248(1):67–76.PubMedCrossRefGoogle Scholar
  58. 58.
    Wegner M, Araszkiewicz A, Piorunska-Stolzmann M, et al. Association between IL-6 concentration and diabetes-related variables in DM1 patients with and without microvascular complications. Inflammation. 2013;36(3):723–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Padgett LE, Broniowska KA, Hansen PA, et al. The role of reactive oxygen species and proinflammatory cytokines in type 1 diabetes pathogenesis. Ann N Y Acad Sci. 2013;1281:16–35.PubMedCrossRefGoogle Scholar
  60. 60.
    O'Connor JC, Johnson DR, Freund GG. Psychoneuroimmune implications of type 2 diabetes: redux. Immunol Allergy Clin N Am. 2009;29(2):339–58.CrossRefGoogle Scholar
  61. 61.
    Lopes-Virella MF, Baker NL, Hunt KJ, et al. Baseline markers of inflammation are associated with progression to macroalbuminuria in Type 1 diabetic subjects. Diabetes Care. 2013.Google Scholar
  62. 62.
    Gustavsson C, Agardh E, Bengtsson B, Agardh CD. TNF-alpha is an independent serum marker for proliferative retinopathy in type 1 diabetic patients. J Diabet Complicat. 2008;22(5):309–16.CrossRefGoogle Scholar
  63. 63.
    • Low CA, Bower JE, Moskowitz JT, Epel ES. Positive psychological states and biological processes. In: Sheldon KM, Kashdan TB, Steger MF, editors. Designing positive psychology: taking stock and moving forward. Oxford: Oxford University Press; 2011. p. 41–50. This chapter provides an extensive overview of the associations between positive psychological states and biological processes, including neuroendocrine function, immune function, and allostasis. As such, it identifies potential mechanisms mediating the relationships between these states and improved health outcomes.CrossRefGoogle Scholar
  64. 64.
    Steptoe A, Wardle J. Positive affect and biological function in everyday life. Neurobiol Aging. 2005;26 Suppl 1:108–12.PubMedCrossRefGoogle Scholar
  65. 65.
    Steptoe A, O'Donnell K, Badrick E, et al. Neuroendocrine and inflammatory factors associated with positive affect in healthy men and women: the Whitehall II study. Am J Epidemiol. 2008;167(1):96–102.PubMedCrossRefGoogle Scholar
  66. 66.
    Brouwers C, Mommersteeg PM, Nyklicek I, et al. Positive affect dimensions and their association with inflammatory biomarkers in patients with chronic heart failure. Biol Psychol. 2013;92(2):220–6.PubMedCrossRefGoogle Scholar
  67. 67.
    Brydon L, Walker C, Wawrzyniak AJ, et al. Dispositional optimism and stress-induced changes in immunity and negative mood. Brain Behav Immun. 2009;23(6):810–6.PubMedCrossRefGoogle Scholar
  68. 68.
    Ikeda A, Schwartz J, Peters JL, et al. Optimism in relation to inflammation and endothelial dysfunction in older men: the VA Normative Aging Study. Psychosom Med. 2011;73(8):664–71.PubMedCrossRefGoogle Scholar
  69. 69.
    Roy B, Diez-Roux AV, Seeman T, et al. Association of optimism and pessimism with inflammation and hemostasis in the Multi-Ethnic Study of Atherosclerosis (MESA). Psychosom Med. 2010;72(2):134–40.PubMedCrossRefGoogle Scholar
  70. 70.
    Bruehl H, Rueger M, Dziobek I, et al. Hypothalamic-pituitary-adrenal axis dysregulation and memory impairments in type 2 diabetes. J Clin Endocrinol Metab. 2007;92(7):2439–45.PubMedCrossRefGoogle Scholar
  71. 71.
    Chiodini I, Adda G, Scillitani A, et al. Cortisol secretion in patients with type 2 diabetes: relationship with chronic complications. Diabetes Care. 2007;30(1):83–8.PubMedCrossRefGoogle Scholar
  72. 72.
    Polk DE, Cohen S, Doyle WJ, et al. State and trait affect as predictors of salivary cortisol in healthy adults. Psychoneuroendocrinology. 2005;30(3):261–72.PubMedCrossRefGoogle Scholar
  73. 73.
    Jacobs N, Myin-Germeys I, Derom C, et al. A momentary assessment study of the relationship between affective and adrenocortical stress responses in daily life. Biol Psychol. 2007;74(1):60–6.PubMedCrossRefGoogle Scholar
  74. 74.
    Butki BD, Rudolph DL, Jacobsen H. Self-efficacy, state anxiety, and cortisol responses to treadmill running. Percept Mot Skills. 2001;92(3 Pt 2):1129–38.PubMedGoogle Scholar
  75. 75.
    Nes LS, Segerstrom SC, Sephton SE. Engagement and arousal: optimism's effects during a brief stressor. Personal Soc Psychol Bull. 2005;31(1):111–20.CrossRefGoogle Scholar
  76. 76.
    Schwerdtfeger A, Konermann L, Schonhofen K. Self-efficacy as a health-protective resource in teachers? A biopsychological approach. Health Psychol. 2008;27(3):358–68.PubMedCrossRefGoogle Scholar
  77. 77.
    Mikolajczak M, Quoidbach J, Vanootighem V, et al. Cortisol awakening response (CAR)'s flexibility leads to larger and more consistent associations with psychological factors than CAR magnitude. Psychoneuroendocrinology. 2010;35(5):752–7.PubMedCrossRefGoogle Scholar
  78. 78.
    Endrighi R, Hamer M, Steptoe A. Associations of trait optimism with diurnal neuroendocrine activity, cortisol responses to mental stress, and subjective stress measures in healthy men and women. Psychosom Med. 2011;73(8):672–8.PubMedCrossRefGoogle Scholar
  79. 79.
    Chida Y, Hamer M. Chronic psychosocial factors and acute physiological responses to laboratory-induced stress in healthy populations: a quantitative review of 30 years of investigations. Psychol Bull. 2008;134(6):829–85.PubMedCrossRefGoogle Scholar
  80. 80.
    American Heart Association. Coronary Artery Disease - Coronary Heart Disease. 2013. Accessed May 26, 2013; 2013.
  81. 81.
    World Heart Federation. Cardiovascular disease risk factors. 2013. Accessed May 26, 2013; 2013.
  82. 82.
    Giltay EJ, Geleijnse JM, Zitman FG, et al. Lifestyle and dietary correlates of dispositional optimism in men: the Zutphen Elderly Study. J Psychosom Res. 2007;63(5):483–90.PubMedCrossRefGoogle Scholar
  83. 83.
    Kneckt MC, Keinanen-Kiukaanniemi SM, Knuuttila ML, Syrjala AM. Self-esteem as a characteristic of adherence to diabetes and dental self-care regimens. J Clin Periodontol. 2001;28(2):175–80.PubMedCrossRefGoogle Scholar
  84. 84.
    Komar-Samardzija M, Braun LT, Keithley JK, Quinn LT. Factors associated with physical activity levels in African-American women with type 2 diabetes. J Am Acad Nurse Pract. 2012;24(4):209–17.PubMedCrossRefGoogle Scholar
  85. 85.
    Plotnikoff RC, Lippke S, Trinh L, et al. Protection motivation theory and the prediction of physical activity among adults with type 1 or type 2 diabetes in a large population sample. Br J Health Psychol. 2010;15(Pt 3):643–61.PubMedCrossRefGoogle Scholar
  86. 86.
    Spangler JG, Konen JC. Predicting exercise and smoking behaviors in diabetic and hypertensive patients. Age, race, sex, and psychological factors. Arch Fam Med. 1993;2(2):149–55.PubMedCrossRefGoogle Scholar
  87. 87.
    Plotnikoff RC, Trinh L, Courneya KS, et al. Predictors of physical activity in adults with type 2 diabetes. Am J Health Behav. 2011;35(3):359–70.PubMedCrossRefGoogle Scholar
  88. 88.
    Delahanty LM, Conroy MB, Nathan DM. Psychological predictors of physical activity in the diabetes prevention program. J Am Diet Assoc. 2006;106(5):698–705.PubMedCrossRefGoogle Scholar
  89. 89.
    Delahanty LM, Peyrot M, Shrader PJ, et al. Pretreatment, psychological, and behavioral predictors of weight outcomes among lifestyle intervention participants in the Diabetes Prevention Program (DPP). Diabetes Care. 2013;36(1):34–40.PubMedCrossRefGoogle Scholar
  90. 90.
    Kyrios M, Moore SM, Hackworth N, et al. The influence of depression and anxiety on outcomes after an intervention for prediabetes. Med J Aust. 2009;190(7 Suppl):S81–5.PubMedGoogle Scholar
  91. 91.
    Laatikainen T, Philpot B, Hankonen N, et al. Predicting changes in lifestyle and clinical outcomes in preventing diabetes: the Greater Green Triangle Diabetes Prevention Project. Prev Med. 2012;54(2):157–61.PubMedCrossRefGoogle Scholar
  92. 92.
    Kopp M, Steinlechner M, Ruedl G, et al. Acute effects of brisk walking on affect and psychological well-being in individuals with type 2 diabetes. Diabetes Res Clin Pract. 2012;95(1):25–9.PubMedCrossRefGoogle Scholar
  93. 93.
    Stewart AL, Hays RD, Wells KB, et al. Long-term functioning and well-being outcomes associated with physical activity and exercise in patients with chronic conditions in the Medical Outcomes Study. J Clin Epidemiol. 1994;47(7):719–30.PubMedCrossRefGoogle Scholar
  94. 94.
    Korkiakangas EE, Alahuhta MA, Husman PM, et al. Motivators and barriers to exercise among adults with a high risk of type 2 diabetes–a qualitative study. Scand J Caring Sci. 2011;25(1):62–9.PubMedCrossRefGoogle Scholar
  95. 95.
    Gao J, Wang J, Zhu Y, Yu J. Validation of an information–motivation–behavioral skills model of self-care among Chinese adults with type 2 diabetes. BMC Public Health. 2013;13(1):100.PubMedCrossRefGoogle Scholar
  96. 96.
    Sousa VD, Zauszniewski JA, Musil CM, et al. Relationships among self-care agency, self-efficacy, self-care, and glycemic control. Res Theory Nurs Pract. 2005;19(3):217–30.PubMedCrossRefGoogle Scholar
  97. 97.
    Wu SF, Huang YC, Lee MC, et al. Self-efficacy, self-care behavior, anxiety, and depression in Taiwanese with type 2 diabetes: a cross-sectional survey. Nurs Health Sci. 2013.Google Scholar
  98. 98.
    Aalto AM, Uutela A. Glycemic control, self-care behaviors, and psychosocial factors among insulin treated diabetics: a test of an extended health belief model. Int J Behav Med. 1997;4(3):191–214.PubMedCrossRefGoogle Scholar
  99. 99.
    Aljasem LI, Peyrot M, Wissow L, Rubin RR. The impact of barriers and self-efficacy on self-care behaviors in type 2 diabetes. Diabetes Educ. 2001;27(3):393–404.PubMedCrossRefGoogle Scholar
  100. 100.
    Sarkar U, Fisher L, Schillinger D. Is self-efficacy associated with diabetes self-management across race/ethnicity and health literacy? Diabetes Care. 2006;29(4):823–9.PubMedCrossRefGoogle Scholar
  101. 101.
    Mishali M, Omer H, Heymann AD. The importance of measuring self-efficacy in patients with diabetes. Fam Pract. 2011;28(1):82–7.PubMedCrossRefGoogle Scholar
  102. 102.
    Park KA, Kim JG, Kim BW, et al. Factors that affect medication adherence in elderly patients with diabetes mellitus. Korean Diabetes J. 2010;34(1):55–65.PubMedCrossRefGoogle Scholar
  103. 103.
    •• Gherman A, Schnur J, Montgomery G, et al. How are adherent people more likely to think? A meta-analysis of health beliefs and diabetes self-care. Diabetes Educ. 2011;37(3):392–408. This meta-analysis of 48 studies found that self-care behaviors in DM patients are associated with self-efficacy (e.g., the belief that one is able to adhere to treatment), the perception of control over diabetes, and the belief that adherence is beneficial (effect size = 0.22).PubMedCrossRefGoogle Scholar
  104. 104.
    de Ridder D, Fournier M, Bensing J. Does optimism affect symptom report in chronic disease? What are its consequences for self-care behaviour and physical functioning? J Psychosom Res. 2004;56(3):341–50.PubMedCrossRefGoogle Scholar
  105. 105.
    Helgeson VS, Honcharuk E, Becker D, et al. A focus on blood glucose monitoring: relation to glycemic control and determinants of frequency. Pediatr Diabetes. 2011;12(1):25–30.PubMedCrossRefGoogle Scholar
  106. 106.
    Nakahara R, Yoshiuchi K, Kumano H, et al. Prospective study on influence of psychosocial factors on glycemic control in Japanese patients with type 2 diabetes. Psychosomatics. 2006;47(3):240–6.PubMedCrossRefGoogle Scholar
  107. 107.
    Abolfotouh MA, Kamal MM, El-Bourgy MD, Mohamed SG. Quality of life and glycemic control in adolescents with type 1 diabetes and the impact of an education intervention. Int J Gen Med. 2011;4:141–52.PubMedCrossRefGoogle Scholar
  108. 108.
    Critchley CR, Hardie EA, Moore SM. Examining the psychological pathways to behavior change in a group-based lifestyle program to prevent type 2 diabetes. Diabetes Care. 2012;35(4):699–705.PubMedCrossRefGoogle Scholar
  109. 109.
    Davies MJ, Heller S, Skinner TC, et al. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ. 2008;336(7642):491–5.PubMedCrossRefGoogle Scholar
  110. 110.
    Deakin TA, Cade JE, Williams R, Greenwood DC. Structured patient education: the diabetes X-PERT Programme makes a difference. Diabet Med. 2006;23(9):944–54.PubMedCrossRefGoogle Scholar
  111. 111.
    Keers JC, Bouma J, Links TP, et al. One-year follow-up effects of diabetes rehabilitation for patients with prolonged self-management difficulties. Patient Educ Couns. 2006;60(1):16–23.PubMedCrossRefGoogle Scholar
  112. 112.
    Nishita C, Cardazone G, Uehara DL, Tom T. Empowered diabetes management: life coaching and pharmacist counseling for employed adults with diabetes. Health Educ Behav. 2012.Google Scholar
  113. 113.
    Pena-Purcell NC, Boggess MM, Jimenez N. An empowerment-based diabetes self-management education program for Hispanic/Latinos: a quasi-experimental pilot study. Diabetes Educ. 2011;37(6):770–9.PubMedCrossRefGoogle Scholar
  114. 114.
    Raballo M, Trevisan M, Trinetta AF, et al. A study of patients' perceptions of diabetes care delivery and diabetes: propositional analysis in people with type 1 and 2 diabetes managed by group or usual care. Diabetes Care. 2012;35(2):242–7.PubMedCrossRefGoogle Scholar
  115. 115.
    Siebolds M, Gaedeke O, Schwedes U. Self-monitoring of blood glucose–psychological aspects relevant to changes in HbA1c in type 2 diabetic patients treated with diet or diet plus oral antidiabetic medication. Patient Educ Couns. 2006;62(1):104–10.PubMedCrossRefGoogle Scholar
  116. 116.
    Sperl-Hillen J, Beaton S, Fernandes O, et al. Are benefits from diabetes self-management education sustained? Am J Manage Care. 2013;19(2):104–12.Google Scholar
  117. 117.
    Amsberg S, Anderbro T, Wredling R, et al. A cognitive behavior therapy-based intervention among poorly controlled adult type 1 diabetes patients–a randomized controlled trial. Patient Educ Couns. 2009;77(1):72–80.PubMedCrossRefGoogle Scholar
  118. 118.
    Bradshaw BG, Richardson GE, Kumpfer K, et al. Determining the efficacy of a resiliency training approach in adults with type 2 diabetes. Diabetes Educ. 2007;33(4):650–9.PubMedCrossRefGoogle Scholar
  119. 119.
    de Wit M, Delemarre-van de Waal HA, Bokma JA, et al. Monitoring and discussing health-related quality of life in adolescents with type 1 diabetes improve psychosocial well-being: a randomized controlled trial. Diabetes Care. 2008;31(8):1521–6.PubMedCrossRefGoogle Scholar
  120. 120.
    Forlani G, Nuccitelli C, Caselli C, et al. A psychological support program for individuals with Type 1 diabetes. Acta Diabetol. 2011.Google Scholar
  121. 121.
    Pouwer F, Snoek FJ, van der Ploeg HM, et al. Monitoring of psychological well-being in outpatients with diabetes: effects on mood, HbA(1c), and the patient's evaluation of the quality of diabetes care: a randomized controlled trial. Diabetes Care. 2001;24(11):1929–35.PubMedCrossRefGoogle Scholar
  122. 122.
    Steinhardt MA, Mamerow MM, Brown SA, Jolly CA. A resilience intervention in African American adults with type 2 diabetes: a pilot study of efficacy. Diabetes Educ. 2009;35(2):274–84.PubMedCrossRefGoogle Scholar
  123. 123.
    von Sengbusch S, Muller-Godeffroy E, Hager S, et al. Mobile diabetes education and care: intervention for children and young people with Type 1 diabetes in rural areas of northern Germany. Diabet Med. 2006;23(2):122–7.CrossRefGoogle Scholar
  124. 124.
    Funnell MM, Brown TL, Childs BP, et al. National standards for diabetes self-management education. Diabetes Care. 2010;33 Suppl 1:S89–96.PubMedCrossRefGoogle Scholar
  125. 125.
    Norris SL, Lau J, Smith SJ, et al. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care. 2002;25(7):1159–71.PubMedCrossRefGoogle Scholar
  126. 126.
    •• Steinsbekk A, Rygg LO, Lisulo M, et al. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res. 2012;12:213. This meta-analysis of 21 studies (2,833 participants) provides evidence that group-based self-management education programs in DM patients lead to improvements in HbA1c, diabetes knowledge, self-management skills, and self-efficacy.PubMedCrossRefGoogle Scholar
  127. 127.
    Bradshaw BG, Richardson GE, Kulkarni K. Thriving with diabetes: an introduction to the resiliency approach for diabetes educators. Diabetes Educ. 2007;33(4):643–9.PubMedCrossRefGoogle Scholar
  128. 128.
    Seligman ME, Steen TA, Park N, Peterson C. Positive psychology progress: empirical validation of interventions. Am Psychol. 2005;60(5):410–21.PubMedCrossRefGoogle Scholar
  129. 129.
    • Bolier L, Haverman M, Westerhof GJ, et al. Positive psychology interventions: a meta-analysis of randomized controlled studies. BMC Public Health. 2013;13:119. This meta-analysis of 39 studies involving mostly healthy individuals found that positive psychology interventions are effective at improving subjective well-being and depression.PubMedCrossRefGoogle Scholar
  130. 130.
    Sin NL, Lyubomirsky S. Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis. J Clin Psychol. 2009;65(5):467–87.PubMedCrossRefGoogle Scholar
  131. 131.
    Cuijpers P, Geraedts AS, van Oppen P, et al. Interpersonal psychotherapy for depression: a meta-analysis. Am J Psychiatry. 2011;168(6):581–92.PubMedCrossRefGoogle Scholar
  132. 132.
    Cuijpers P, Smit F, Bohlmeijer E, et al. Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. Br J Psychiatry. 2010;196(3):173–8.PubMedCrossRefGoogle Scholar
  133. 133.
    Mancuso CA, Choi TN, Westermann H, et al. Increasing physical activity in patients with asthma through positive affect and self-affirmation: a randomized trial. Arch Intern Med. 2012;172(4):337–43.PubMedCrossRefGoogle Scholar
  134. 134.
    Ogedegbe GO, Boutin-Foster C, Wells MT, et al. A randomized controlled trial of positive-affect intervention and medication adherence in hypertensive African Americans. Arch Intern Med. 2012;172(4):322–6.PubMedCrossRefGoogle Scholar
  135. 135.
    Peterson JC, Charlson ME, Hoffman Z, et al. A randomized controlled trial of positive-affect induction to promote physical activity after percutaneous coronary intervention. Arch Intern Med. 2012;172(4):329–36.PubMedCrossRefGoogle Scholar
  136. 136.
    Huffman JC, Mastromauro CA, Boehm JK, et al. Development of a positive psychology intervention for patients with acute cardiovascular disease. Heart Int. 2011;6:e14.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Christopher M. Celano
    • 1
    • 2
    Email author
  • Eleanor E. Beale
    • 2
  • Shannon V. Moore
    • 2
  • Deborah J. Wexler
    • 1
    • 3
  • Jeff C. Huffman
    • 1
    • 2
  1. 1.Harvard Medical SchoolBostonUSA
  2. 2.Department of PsychiatryMassachusetts General Hospital / Blake 11BostonUSA
  3. 3.Department of Medicine, Diabetes UnitMassachusetts General HospitalBostonUSA

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