The aim of the study was to explore heterogeneity of change in state affect following the introduction of insulin therapy in patients with type 2 diabetes. State affect was assessed twice among 305 patients: just before the introduction of insulin therapy and at 1-month follow-up. Latent class growth modeling showed that negative affect (NA) increased in 78% of the sample, whereas positive affect (PA) improved in only 17% of the participants. On the basis of cross-tabulation of these changes a 4-class model of emotional response to the new treatment was obtained. The largest subgroup of participants (57%) manifested “threat response”, i.e. moderate-stable PA with increase in NA. Participants in the “challenge response” subgroup (11.8%) showed increases in both NA and PA. The third class (10.2%) characterized by “no response”, had low-stable NA and moderate-stable PA. The smallest “stress response” subgroup (9.8%) showed increase in NA and high-stable PA. Gender, age and education level were significant covariates of group membership. Thus, the findings revealed heterogeneous emotional response to the new treatment, which may be of clinical relevance for improving diabetic patients’ adjustment through a more individual, person-centered approach.
Bonanno, G.A., Wortman, C.B., Lehman, D.R., Tweed, R.G., Haring, M., Sonnega, J., Carr, D., & Neese, R.M. (2002). Resilience to loss and chronic grief: A prospective study from pre-loss to 18 months postloss. Journal of Personality and Social Psychology, 83, 1150-1164.
Bonanno, G.A., Ho, S.M.Y., Chan, J.C.K, Kwong, R.S.Y., Cheung, C.K.Y., Wong, C.P.Y., & Wong, V.C.W. (2008). Psychological resilience and dysfunction among hospitalized survivors of the SARS epidemic in Hong Kong: A latent class approach. Health Psychology, 27, 659-667.
Bradley, C., & Gilbride, C.J. (2008). Improving treatment satisfaction and other patient-reported outcomes in people with type 2 diabetes: the role of once-daily insulin glargine. Diabetes, Obesity & Metabolism, 10, 50-65.
Brod, M., Kongsø, J.H., Lessard, S., & Christensen, T.L. (2009) Psychological insulin resistance: patient beliefs and implications for diabetes management. Quality of Life Research, 18, 23-32. doi:
Brown, G.C., Brown, M.M., Sharma, S., Brown, H., Gozum, M., & Denton, P. (2000). Quality of Life Associated with Diabetes Mellitus in an Adult Population. Journal of Diabetes and Its Complications, 14, 18-24.
Brzozowski, P. (2010). Skala Uczuć Pozytywnych i Negatywnych. Polska adaptacja PANAS. Podręcznik. [Positive and Negative Affect Schedule. Polish adaptation of PANAS. Manual]. Warszawa: Pracownia Testów Psychologicznych PTP.
Chiu, Ch.-J., Wray, L.A. (2011). Gender differences in functional limitations in adults living with type 2 diabetes: biobehavioral and psychosocial mediators. Annals of Behavioral Medicine, 41, 71-82.
Crawford, J.R., & Henry, J.D. (2004). The positive and negative affect schedule (PANAS): construct validity, measurement properties and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 43, 245-265.
Davidson, R.J., Ekman, P., Saron, C.D., Senulis, J.A., & Friesen, W.V. (1990). Approach-Withdrawal and Cerebral Asymmetry: Emotional Expression and Brain Physiology I. Journal of Personality and Social Psychology, 58, 330-341.
Davis, T.M.E., Clifford, R.M., & Davis, W.E. (2001). Effect of insulin therapy on quality of life in Type 2 diabetes mellitus: The Fremantle Diabetes Study. Diabetes Research and Clinical Practice, 52, 63-71.
de Cock, E.S.A., Emons, W.H.M., Nefs, G., Pop, V.J.M., Pouwer, F. (2011). Dimensionality and scale properties of the Edinburgh Depression Scale (EDS) in patients with type 2 diabetes mellitus: the DiaDDzoBstudy. BMC Psychiatry, 11, 141.
de Grauw, W.J., van de Lisdonk, E.H., van Gerwen, W.H., van den Hoogen, H.J., & van Weel, C. (2001). Insulin therapy in poorly controlled type 2 diabetic patients: does it affect quality of life? British Journal of General Practice, 468, 527-532.
de Sonnaville, J.J., Snoek, F.J., Colly, L.P., Deville, W., Wijkel, D., & Heine, R. (1998). Well-being and symptoms in relation to insulin therapy in type 2 diabetes. Diabetes Care, 21, 919-924.
Diener, E., Lucas, R.E., & Scollon, C.N. (2006). Beyond the hedonic treadmill: Revising the adaptation theory of well-being. American Psychologist, 61, 305-314.
Egloff, B. (1998). The independence of posit ive and negative affect depends on the affect measure. Personality and Individual Differences, 25, 1101-1109.
Folkman, S. (1997). Positive psychological states and coping with severe stress. Social Science and Medicine, 45, 1207-1221.
Folkman, S. (2008). The case for positive emotions in the stress process. Anxiety, Stress, & Coping, 21, 3-14.
Folkman, S., & Lazarus, R.S. (1985). If it changes it must be a process: Study of emotion and coping during three stages of a collage examination. Journal of Personality and Social Psychology, 48, 150-170.
Folkman, S., & Moskowitz, J.T (2000). Stress, positive emotion, and coping. Current Directions in Psychological Science, 9, 115-118.
Fredrickson, B.L. (1998). What good are positive emotions? Review of General Psychology, 2, 300-319.
Gallo, L.C., & Matthews, K.A. (2003). Unders tanding the association between socioeconomic status and physical health: Do negative emotions play a role? Psychological Bulletin, 129, 10-51.
Goddijn, P.P., Bilo, H.J., Feskens, E.J., Groenirt, K.H., van der Zee, K.I., & Mayboom-de Jong, B. (1999). Longitudinal study on glycaemic control and quality of life in patients with Type 2 diabetes mellitus referred for intensifi ed control. Diabetes Medicine, 16, 23-30.
Graham, J.W. (2009). Missing data analysis: Making it work in the real world. Annual Review of Psychology, 60, 549-576. doi:
Hajos, T.R., Pouwer, F., de Grooth R., Holleman, F., Twisk, J.W., Diamant, M., Snoek, F.J. (2012). The longitudinal association between glycaemic control and health-related quality of life following insulin therapy optimisation in type 2 diabetes patients. A prospective observational study in secondary care. Quality of Life Research, 21, 1359-65. doi:
Hendra, T.J., & Taylor, C.D. (2004). A randomised trial of insulin on wellbeing and carer strain in elderly type 2 diabetic subjects. Journal Of Diabetes And Its Complications, 18, 148-54.
Hermanns, N., Mahr, M., Kulzer, B., Skovlund, S.E., & Haak, T. (2010). Barriers towards insulin therapy in type 2 diabetic patients: results of an observational longitudinal study. Health and Quality of Life Outcomes, 8, 113.
Heszen, I. (2013). Psychologia stresu. [Psychology of stress]. Warszawa: Wydawnictwo Naukowe PWN.
Heszen-Niejodek, I., Gottschalk, L.A., & Januszek, M. (1999). Anxiety and hope during the course of three different medical illnesses: A longitudinal study. Psychotherapy and Psychosomatics, 68, 304-312.
Hobfoll, S.E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologist, 44, 513-524.
Jelsness-Jorgensen, L.-P., Ribu, L., Bernklev, T., Moum, B.A. (2011). Measuring health-related quality of life in non-complicated diabetes patients may be an effective parameter to assess patients at risk of a more serious disease course: a cross-sectional study of two diabetes outpatient groups. Journal of Clinical Nursing, 20, 1255-1263.
Lazarus, R.S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.
Lyubomirsky, S. (2011). Hedonic adaptation to positive and negative experiences. In S. Folkman (Eds.), The Oxford Handbook of Stress, Health, And Coping (pp.200-224). Oxford: University Press.
Mancini, A.D., Bonanno, G.A., & Clark, A. (2011). Stepping off the hedonic treadmill: Individual differences in response to major life events. Journal of Individual Differences, 32, 144-152.
McLachlan, G., & Peel, D. (2000). Finite mixture models. New York: Wiley.
Muthén, B., & Muthén, L.K. (2000). Integrating Person-Centered and Variable-Centered Analyses: Growth Mixture Modeling With Latent Trajectory Classes. Alcoholism: Clinical and Experimental Research, 24, 882-891. doi:
Niswender, K. (2009). Early and Aggressive Initiation of Insulin Therapy for Type 2 Diabetes: What Is the Evidence? Clinical Diabetes Spring, 27, 60-68.
Nylund, K.L., Asparouhov, T., & Muthen, B.O. (2007). Deciding on the Number of Classes in Latent Class Analysis and Growth Mixture Modeling: A Monte Carlo Simulation Study. Structural Equation Modeling: A Multidisciplinary Journal, 14, 535-569.
Peyrot, M., Barnett, A.H., Meneghini, L.F., & Shumm-Draeger, P.-M. (2012). Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in Insulin Therapy study. Diabetic Medicine: A Journal Of The British Diabetic Association, 29, 682-689. doi:
Peyrot, M., Rubin, R.R., Lauritzen, T., Skovlund, S.E., Snoek, F.J., Matthews, D.R., Landgraf, R., & Kleinbreit, L. (2005). Resistance to insulin therapy among patients and providers. Diabetes Care, 28, 2673-2679.
Raudenbush, S.W. (2001). Comparing personal trajectories and drawing causal inferences from longitudinal data. Annual Review of Psychology, 52, 501-525.
Reach, G., Le Pautremat, V., & Gupta, Sh. (2013). Determinants and consequences of insulin initiation for type 2 diabetes in France. Patient Preference and Adherence, 7, 1007-1023. doi:
Reich, J.W., Zautra, A.J., & Potter, P.T. (2001). Cognitive structure and the independence of positive and negative affect. Journal of Social and Clinical Psychology, 20, 99-115.
Reza, M., Taylor, C.D., Towse, K., Ward, J.D., & Hendra, T.J. (2002). Insulin improves well-being for selected elderly type 2 diabetic subjects. Diabetes Research And Clinical Practice, 55, 201-207.
Schilling, O.K., & Wahl, H.-W. (2006). Modeling late life adaptation in affective well-being under a severe chronic health condition: The case of age-related macular degeneration. Psychology and Aging, 21, 703-714. doi:
Skinner, T.C., Carey, M.E., Cradock, S., Dallosso, H.M., Daly, H., & Davies, M.J., … (2011). Comparison of illness representations dimensions and illness representation clust ers in predicting outcomes in the first year following diagnosis of type 2 diabetes: results from the DESMOND trial. Psychology & Health, 26, 321-335.
Snoek, F.J., Skovlund, S.E., Pouwer, F. (2007). Development and validation of the insulin treatment appraisal scale (ITAS) in patients with type 2 diabetes. Health Quality of Life Outcomes, 5, 69.
Tugade, M.M. (2011). Positive emotions and coping: examining dualprocess models of resilience. In S. Folkman (Eds.), The Oxford Handbook of Stress, Health, And Coping (pp.186-199). Oxford: University Press.
UKPDS 37 (1999). Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37). U.K. Prospective Diabetes Study Group. Diabetes Care, 22, 1125-1136.
Vijan, S., Hayward , R.A., Ronis, D.L., & Hofer, T.P. (2005). Brief report: the burden of diabetes therapy: implications for the design of effective patient-centered treatment regimens. Journal of General Internal Medicine, 5, 479-482.
Watson, D., Clark, L.A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS Scales. Journal of Personality and Social Psychology, 54, 1063-1070.
Wild, S., Roglic, G., Green, A., Sicree, R., & King, H. (2004). Global prevalence of diabetes. Diabetes Care, 27, 1047-1053.