Type D Personality and Diabetes Self-Management in Type 2 Diabetes: A Mediation–Moderation Model on Glycemic Control and Quality of Life

Type D Personality and Diabetes Self-Management in Type 2 Diabetes: A Mediation–Moderation Model on Glycemic Control and Quality of Life | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Type D Personality and Diabetes Self-Management in Type 2 Diabetes: A Mediation–Moderation Model on Glycemic Control and Quality of Life Meltem Hazel Şimşek, Ulaş Korkmaz, Sefer Aslan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8181318/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background This study aims to examine the role of Type D personality in diabetes control, diabetes self-management, and quality of life in patients with Type 2 Diabetes Mellitus (T2DM). The management of this disease is critical in terms of complications and quality of life. Psychosocial factors can negatively affect diabetes management and the course of the disease. Although studies comparing patients with healthy controls exist, differences in diabetes management and regulation levels have not been sufficiently investigated. Methods This cross-sectional, comparative study involved 318 participants: 109 with regulated T2DM, 101 with disregulated T2DM, and 108 healthy controls. Individuals with T2DM completed the DSMQ, HADS, DS14, and SF-36 scales, while healthy controls completed all except the DSMQ. Statistical analyses included group comparisons, binary logistic regression, and mediation/moderation analyses using the SPSS PROCESS macro. Results In individuals with dysregulated T2DM, Type D personality traits were found to be more common, anxiety and depression levels were higher, and diabetes self-management and quality of life were lower. Type D personality is associated with low self-management skills and reduced quality of life. Diabetes self-management has been found to partially mediate the negative effects of Type D personality on health and to weaken the positive effects of self-management. Conclusions Type D is associated with lower quality of life and poor self-management in individuals with T2DM due to high anxiety and inadequate diabetes management. It demonstrates that Type D, affect both behavior and psychology in diabetes care. Treatment should assess psychological distress and personality and develop strategies targeting these issues to improve disease management and quality of life. Diabetes mellitus Type 2 Type D personality Self-management Anxiety Quality of life Figures Figure 1 Figure 2 Highlights • Type D personality is associated with poorer glycemic control in patients with Type 2 diabetes • Type D is associated with poorer diabetes self-management and lower quality of life • High anxiety and impaired self-management are key predictors of poor glycemic control • Diabetes self-management mediates the negative effect of Type D personality on perceived general health • Type D personality moderates the relationship between diabetes self-management and emotional role limitations 1. Background Tip 2 diyabetes mellitus (T2DM) is a chronic metabolic disease that is a major public health problem worldwild. Reports from 2021 revealed that approximately 508 million people were diagnosed with T2DM [ 1 ]. People with T2DM should be able to control their blood sugar levels well. If T2DM is not well managed, it can lead to serious problems. People's quality of life may decrease substantially, and their health costs may increase. A significant proportion of patients diagnosed with T2DM cannot achieve the desired regulation despite effective pharmacological treatments [ 2 ]. Therefore, in addition to pharmacological approaches, diabetes self-management, including medication adherence, nutrition, and exercise, should also be considered in the control of the disease. Psychosocial factors also play a significant role in the possible outcomes of T2DM. Studies have shown that 25–55% of individuals with T2DM experience moderate to severe psychological distress, such as anxiety, depression, and stress [ 3 , 4 ]. These psychological difficulties are both a consequence of having T2DM and factors that negatively influence the course of the disease. They impair adherence to diet, exercise, and treatment among individuals with T2DM. Moreover, they reduce social participation, adversely affect glycemic control, and decrease quality of life [ 5 ]. Therefore, thoroughly understanding the psychosocial characteristics that disrupt diabetes self-management and negatively influence diabetes regulation is highly important. Personality traits can influence the regulation of T2DM. In recent years, the relationship between diabetes and Type D personality traits has attracted increasing attention. A type D personality is a personality pattern characterized by the coexistence of negative affectivity and social inhibition. Individuals with Type D personalities report higher levels of psychological distress, hopelessness, and social isolation [ 6 ]. This condition particularly affects health behaviors and physiological stress responses in a negative manner. Furthermore, Type D personality makes coping with illnesses more difficult, reduces social support, and therefore adversely affects medical prognosis [ 7 ]. This personality pattern has been recognized as an autonomous risk factor for negative outcomes in several chronic diseases, including cardiovascular disorders and diabetes [ 6 , 7 ]. Recent studies have reported that Type D personality is prevalent among patients with diabetes and that it complicates disease management [ 8 ]. In individuals with T2DM, Type D personality is associated with poor medication adherence, inadequate self-care, and unhealthy lifestyle behaviors [ 7 , 8 ]. Furthermore, it has been demonstrated that patients with T2DM who possess Type D personality traits have significantly lower quality of life [ 9 ]. This personality structure markedly increases levels of diabetes-related stress, anxiety, and depression. These psychosocial factors, in turn, play a mediating role in the deterioration of quality of life among individuals with [ 10 ]. In the literature, a consistent and positive relationship has been identified between diabetes self-management and quality of life among patients with T2DM [ 11 ]. Numerous studies have also reported that diabetes self-management is impaired in patients with T2DM who exhibit Type D personality traits [ 12 ]. However, few studies have investigated how Type D personality characteristics indirectly affect quality of life through diabetes self-management in individuals with T2DM. The literature indicates that Type D personality and psychosocial factors may be associated with poor glycemic control. However, studies that systematically compare T2DM patients with good and poor glycemic control, that is, different patient subgroups, in terms of Type D personality traits and psychosocial factors are limited. Moreover, comparing these subgroups with healthy controls may provide important insights into whether the observed differences are specific to diabetes. In this study, we sought to examine the impact of Type D personality traits on diabetes regulation and self-management, along with their correlation with quality of life in individuals diagnosed with T2DM. This study's hypotheses are as follows: H1: The frequency of Type D personality traits is greater in the dysregulated T2DM group than in the regulated T2DM group and healthy controls. H2: T2DM patients with Type D personality traits exhibit lower self-management skills. H3: Type D personality moderates the relationship between diabetes self-management and quality of life. H4: In patients with T2DM, Type D personality is positively associated with levels of anxiety and depression. H5: There is an indirect effect between Type D personality and quality of life through diabetes self-management. 2. Materials and Methods 2.1. Study Design and Sample This study was conducted with a cross-sectional and comparative design. The sample size was determined via the G*Power program, with a Type I error rate of 5%, a statistical power of 95%, and a medium effect size (0.25). On the basis of on these parameters, the minimum required number of participants for each group was calculated to be 84 [ 13 ]. A total of 210 patients aged between 30 and 75 years who were diagnosed with T2DM and were referred to the Internal Medicine outpatient clinics of Giresun Training and Research Hospital were included in the study. The diagnosis of diabetes was based on medical records confirmed by an internal medicine specialist, in accordance with the criteria of the Turkish Society of Endocrinology and Metabolism’s Guidelines for the Diagnosis, Treatment, and Follow-up of Diabetes Mellitus and Its Complications (2024), which define T2DM as hemoglobin A1c (HbA1c) ≥ 6.5%(48 mmol/mol) or fasting plasma glucose ≥ 126 mg/Dl (7.0 mmol/L) [ 14 ]. The group with regulated diabetes was determined on the basis of blood samples taken on the day of inclusion in the study, according to the following criteria: HbA1c ≤ 7%(53 mmol/mol), fasting blood glucose between 80–130 mg/dL(4.4–7.2 mmol/L), postprandial blood glucose < 180 mg/dL(10.0 mmol/L), and absence of hypoglycemia [ 14 ]. Those who did not meet these criteria were classified as having dysregulated T2DM. The healthy control group consisted of individuals without any psychiatric or diabetes diagnosis. This group was selected to have characteristics similar to those of the study group in terms of age and sex. The purpose of the study was explained to all three groups, and written informed consent was obtained. 2.2. Exclusion criteria The exclusion criteria for this study included the presence of type 1 diabetes, gestational diabetes, or secondary diabetes. In addition, individuals with acute diabetes-related complications or a history of severe hypoglycemia were excluded from the study. Other exclusion criteria were as follows: cognitive impairment that could prevent completion of the scales; the presence of severe neurological diseases; the presence of active malignancy; the presence of advanced comorbid physical diseases; the presence of an active psychiatric disorder; pregnancy and lactation; and the presence of an acute infection. 2.3. Data collection instruments A sociodemographic and clinical data form specifically developed for this study was used to collect descriptive information. The form included items on age, sex, marital status, education level, disease duration, current diabetes treatment, comorbidities, and smoking history. In addition, laboratory measurements obtained on the day of study enrollment (HbA1c, fasting glucose, and postprandial glucose) were recorded using this form. The English version of the form, developed by the research team, is provided as Supplementary File 1. Diabetes Self-Management Questionnaire (DSMQ) : This self-report scale was developed to assess the level of active participation of individuals with diabetes in managing their disease and self-care. The scale was initially developed by Schmitt et al. [ 15 ], and its Turkish validity and reliability studies were conducted by Eroğlu and Sabuncu [ 16 ]. The DSMQ consists of 16 items grouped into four subscales: glucose management, dietary control, physical activity, and health-care use. It is a 4-point Likert-type scale, with items rated from 0 to 3. Higher scores indicate better diabetes self-management. In the Turkish adaptation study, the Cronbach’s alpha coefficient of the scale was reported as 0.85, and the intraclass correlation coefficients for the subscales ranged between 0.97 and 0.99. Hospital Anxiety and Depression Scale (HADS) This self-report scale was developed by Snaith [ 17 ] to assess symptoms of anxiety and depression in individuals. It was specifically designed to distinguish psychological symptoms that accompany physical illnesses. The scale consists of 14 items, of which 7 assess anxiety and 7 assess depression. Each item is rated on a 4-point scale ranging from 0 to 3, with each subscale yielding a total score between 0 and 21. A Turkish validity and reliability study was conducted by Aydemir et al. [ 18 ]. In that study, the Cronbach’s alpha coefficient was 0.8525 for the anxiety subscale and 0.7784 for the depression subscale. The test–retest reliability coefficient was 0.7618 for anxiety and 0.8069 for depression. Factor analysis confirmed a two-factor structure corresponding to anxiety and depression. Type D Personality Scale (DS14) This scale was developed by Denollet. It assesses individuals’ levels of negative affectivity (NA) and social inhibition (SI) [ 19 ]. The scale consists of two subdimensions, each containing 7 items, for a total of 14 items. The participants evaluate each item on a 5-point Likert scale (0 = false, 4 = true). A score of ≥ 10 on each subdimension indicates that the individual has a Type D personality trait. The Turkish validity and reliability study was conducted by Öncü et al. (2018) [ 20 ]. For this scale, the Cronbach’s alpha coefficient was 0.85 for negative affectivity and 0.76 for social inhibition, while the test–retest correlation coefficient was 0.75/0.77. Short Form-36 Quality of Life Scale (SF-36) This self-report instrument, developed by Ware and Sherbourne [ 21 ], evaluates individuals’ quality of life across eight dimensions. These dimensions include physical functioning, social functioning, role limitations due to physical problems, role limitations due to emotional problems, mental health, pain, vitality, and general health perceptions. The scale consists of 36 items, each scored from 0 to 100, with higher scores indicating better quality of life. A Turkish validity and reliability study was conducted by Koçyiğit et al. [ 22 ]. In that study, the Cronbach’s alpha coefficients for the subscales ranged between 0.73 and 0.76, and the item–total correlations varied from 0.47 to 0.88. Additionally, the scale demonstrated significant correlations with the Nottingham Health Profile, ranging from 0.44 to 0.65. These findings indicate that the Turkish version of the SF-36 is a valid, reliable instrument with high internal consistency. 2.4. Ethical Approval This study was approved by the Ethics Committee of Giresun Training and Research Hospital (Decision No: [19.03.2025/12], Date: [24.03.2025]). Written informed consent was obtained from all participants. The study was conducted in accordance with the principles of the Declaration of Helsinki (2013). 2.5. Statistical analysis The data were analyzed via SPSS version 27. The normality assumption for continuous variables was assessed by examining skewness and kurtosis values within the ±1.5 range [23]. For variables with a normal distribution, independent samples t-tests and one-way ANOVA were applied, whereas for nonnormally distributed variables, Mann–Whitney U and Kruskal–Wallis H tests were used. Differences between categorical variables were examined via the chi-square test. To control for confounding variables that differed between groups, MANCOVA models were constructed. When significant differences were found among groups, Tukey, Games–Howell, or Bonferroni-adjusted post-hoc analyses were performed. To determine the predictors of dysregulation, binary logistic regression analysis was conducted, and the results are reported as odds ratios (ORs) with 95% confidence intervals (CIs). In addition, the SPSS PROCESS macro [24] was used to examine the relationships among psychosocial variables. Within this framework: • Using Model 4, the mediating role of diabetes self-management in the relationship between Type D personality and quality of life dimensions was tested. • Model 1 was used to evaluate the moderating role of Type D personality in the effect of diabetes self-management on quality of life. A significance level of p < 0.05 was accepted for all analyses. 3. Results Age and years of education were similar across groups, with no statistically significant differences. The sex distribution was balanced among all three groups. No significant group differences were observed in income level or place of residence. Similarly, there were no significant differences between the groups in terms of psychiatric history, smoking status, or alcohol use. The proportion of participants with comorbid conditions was highest in the dysregulated group (80.2%), followed by the regulated group (69.7%) and the control group (53.7%), and this difference was statistically significant. Table 1 presents the distribution of participants’ sociodemographic characteristics by group. Table 1. Distribution of participants’ sociodemographic characteristics by group Mean ± SD, Median (Q1-Q3), n (%) Regulated DM (n = 109) Dysregulated DM (n = 101) Healthy Control (n =108) Statistic p Value Age (years) 60 (53-65) 60 (52.5-64) 59 (46.5-63.75) H = 2.894 0.235 Education (years) 7.06 ± 4.61 6.71 ± 4.26 7.81 ± 3.87 F = 1.817 0.164 Gender X² = 0.935 0.627 Female 58 (53.2%) 47 (46.5%) 54 (50%) Male 51 (46.8%) 54 (53.5%) 54 (50%) Income level X² = 5.072 0.280 ≤1 minimum wage 64 (58.7%) 69 (68.3%) 60 (55.6%) 2 minimum wages 26 (23.9%) 22 (21.8%) 27 (25%) ≥3 minimum wages 19 (17.4%) 10 (9.9%) 21 (19.4%) Place of residence X² = 5.790 0.055 Urban 54 (49.5%) 38 (37.6%) 58 (53.7%) Rural 55 (50.5%) 63 (62.4%) 50 (46.3%) Comorbid disease X² = 17.068 <0.001 None 33 (30.3%) 20 (19.8%) 50 (46.3%) Present 76 (69.7%) 81 (80.2%) 58 (53.7%) Psychiatric history X² = 1.338 0.512 Present 29 (26.6%) 26 (25.7%) 22 (20.4%) Absent 80 (73.4%) 75 (74.3%) 86 (79.6%) Family history of DM X² = 18.156 <0.001 Present 57 (52.3%) 69 (68.3%) 42 (38.9%) Absent 52 (47.7%) 32 (31.7%) 66 (61.1%) Smoking X² = 0.573 0.751 Smoker 33 (30.3%) 35 (34.7%) 33 (30.6%) Non-smoker 76 (69.7%) 66 (65.3%) 75 (69.4%) Alcohol use X² = 5.658 0.059 User 15 (13.8%) 12 (11.9%) 25 (23.1%) Non-user 94 (86.2%) 89 (88.1%) 83 (76.9%) n = sample size; p = statistical significance level; Q1 = first quartile; Q3 = third quartile; SD = standard deviation; F = ANOVA test statistic; H = Kruskal–Wallis H test statistic; X² = chi-square test statistic DM = diabetes mellitus. Table 2 presents the clinical indicators of T2DM along with measures of diabetes self-management, psychological status, quality of life, and Type D personality traits. The duration of diabetes diagnosis did not differ significantly between the two patient groups. The total DSMQ score and its subscales were higher in the regulated group and markedly lower in the dysregulated group. For the HADS subscales, anxiety and depression scores were highest in the dysregulated group, lowest in the healthy control group, and intermediate in the regulated group. With respect to the SF-36 subscales, particularly physical functioning, role limitations due to physical and emotional problems, vitality, mental health, social functioning, pain, and general health, the control group had the highest scores, whereas the dysregulated group had the lowest scores. The regulated group ranked between the two. When the total score and components of the Type D Personality Scale were examined, both diabetes groups presented higher scores than did the healthy control group, with the dysregulated group having the highest scores, followed by the regulated and control groups. The proportion of participants classified as Type D positive also differed among the groups, with the prevalence ranking as follows: Dysregulated ≥ Regulated ≥ Control. Table 2. Comparison of clinical characteristics, self-management, psychological status, quality of life, and Type D personality measures among groups Mean ± SD, Median (Q1-Q3), n (%) Regulated DM (n = 109) Dysregulated DM (n = 101) Healthy Control (n =108) Statistic p Value Post hoc Duration of DM diagnosis 6.28 ± 4.47 7.52 ± 5.05 - t = -1.902 0.059 DSMQ (Total) 6.25 ± 1.84 4.39 ± 1.83 - F = 53.785 <0.001 Glucose management 6.74 ± 2.03 4.93 ± 2.234 - F = 37.837 <0.001 Dietary control 5.90 ± 2.16 3.77 ± 2.10 - F = 52.400 <0.001 Physical activity 4.92 ± 2.86 3.40 ± 2.43 - F = 17.209 <0.001 Health-care use 7.14 ± 2.00 5.27 ± 2.50 - F = 35.934 <0.001 HADS-Anxiety 7.06 ± 4.54 8.12 ± 5.26 5.11 ± 3.37 F = 14.981 R > C HADS-Depression 7.39 ± 4.85 8.67 ± 4.59 4.19 ± 3.15 F = 21.825 C SF-36 Physical functioning 75 (45-90) 60 (42.50-85) 90 (75-95) H = 52.470 R = D SF-36 Role limitations (physical) 51.61 ± 35.07 42.82 ± 36.46 65.74 ± 33.94 F = 9.432 <0.001 C ≥ R ≥ D SF-36 Role limitations (emotional) 66.67 (0-100) 33.33 (0-66.67) 66.67 (33.33-100) H = 22.334 R = D SF-36 Vitality 52.11 ± 23.42 46.83 ± 24.97 60.83 ± 18.53 F = 7.075 <0.001 C ≥ R ≥ D SF-36 Mental health 58.90 ± 20.36 55.09 ± 20.48 64.41 ± 17.01 F = 3.598 0.029 C ≥ R ≥ D SF-36 Social functioning 60.67 ± 22.87 53.87 ± 26.37 74.77 ± 20.93 F = 15.109 R = D SF-36 Pain 56.40 ± 27.54 54.28 ± 27.13 73.80 ± 22.20 F = 14.757 R = D SF-36 General health 49.13 ± 21.77 42.20 ± 21.86 65.09 ± 17.55 F = 25.165 R = D DS14 (Total) 20.86 ± 15.61 25.50 ± 15.58 16.28 ± 13.79 F = 7.033 0.001 D ≥ R ≥ C Negative affectivity 8 (3-20) 17 (4-22) 5 (2-17) H = 19.150 C Social inhibition 9.31 ± 7.30 11.45 ± 7.35 7.36 ± 6.09 F = 7.465 <0.001 D ≥ R ≥ C Type D personality X² = 10.347 0.006 D ≥ R ≥ C Type D (–) 62 (56.9%) 46 (45.5%) 73 (67.6%) Type D (+) 47 (43.1%) 55 (54.5%) 35 (32.4%) n = sample size; p = statistical significance level; Q1 = first quartile; Q3 = third quartile; SD = standard deviation; F = MANCOVA test statistic (controlled for the presence of comorbid diseases); H = Kruskal–Wallis H test statistic; t = t-test statistic; X² = chi-square test statistic DM = diabetes mellitus; D = dysregulated DM; R = regulated DM; C = healthy control; HADS = Hospital Anxiety and Depression Scale; DS14 = Type D Personality Scale; SF-36 = Short Form-36; DSMQ = Diabetes Self-Management Questionnaire In Table 3, diabetic patients were divided into two groups on the basis of the presence or absence of Type D personality traits and compared accordingly. HbA1c levels did not differ significantly between the Type D-positive and Type D-negative groups. However, there were marked differences in psychological status and quality of life parameters between the two groups. Patients with Type D personality traits had significantly higher HADS-Anxiety and HADS-Depression scores. For all subdimensions of the SF-36, the scores of the Type D positive group were significantly lower. Similarly, diabetes self-management and all of its subscales were also lower among individuals with Type D personality. Table 3. Comparison of diabetic patients by Type D personality characteristics in terms of clinical and psychosocial characteristics Mean ± SD, Median (Q1-Q3) Type D (-) (n = 108) Type D (+) (n = 102) Statistic p Value HbA1c 7.70 ± 2.11 8.06 ± 2.22 t = -1.185 0.238 HADS-Anxiety 4 (3-7) 11 (8-14) Z = -8.933 <0.001 HADS-Depression 4.87 ± 3.64 11.32 ± 3.35 t = -13.353 <0.001 SF-36 Physical functioning 85 (75-93.75) 45 (28.75-56.25) Z = -9.442 <0.001 SF-36 Role limitations (physical) 67.36 ± 30.27 26.23 ± 28.66 t = 10.099 <0.001 SF-36 Role limitations (emotional) 70.37 ± 30.43 25.82 ± 33.79 t = 10.063 <0.001 SF-36 Vitality 65.42 ± 17.54 32.79 ± 18.42 t = 13.147 <0.001 SF-36 Mental health 70.22 ± 15.07 43.14 ± 15.64 t = 12.782 <0.001 SF-36 Social functioning 71.44 ± 30.32 42.52 ± 20.00 t = 10.385 <0.001 SF-36 Pain 67.04 ± 25.39 43.04 ± 23.68 t = 7.073 <0.001 SF-36 General health 59.02 ± 19.22 31.96 ± 15.29 t = 11.289 <0.001 DSMQ (Total) 6.32 ± 1.95 4.34 ± 1.63 t = 7.951 <0.001 Glucose management 6.80 ± 2.18 4.89 ± 2.03 t = 6.554 <0.001 Dietary control 5.88 ± 2.23 3.82 ± 2.06 t = 6.959 <0.001 Physical activity 5.29 ± 2.68 3.04 ± 2.36 t = 6.409 <0.001 Health-care use 7.08 ± 2.19 5.35 ± 2.37 t = 5.492 <0.001 n = sample size; p = statistical significance level; Q1 = first quartile; Q3 = third quartile; SD = standard deviation; t = t-test statistic; Z = Mann–Whitney U test statistic DM = diabetes mellitus; HADS = Hospital Anxiety and Depression Scale; SF-36 = Short Form-36; DSMQ = Diabetes Self-Management Questionnaire A binary logistic regression analysis was conducted to identify the factors distinguishing regulated (coded 0) and dysregulated (coded 1) diabetic patients (Table 4). In the first model, only the Type D Personality Scale (DS14) total score was included. Each one-point increase in DS14 was associated with a 1.9% greater likelihood of being dysregulated (OR = 1.019, 95% CI: 1.001–1.037). The DSMQ, HADS-Anxiety, and HADS-Depression scores were subsequently added to the model. In this extended model, each one-point increase in DSMQ score was associated with an approximately 50% reduction in the odds of being dysregulated (OR = 0.523, 95% CI: 0.422–0.649), whereas higher HADS-Anxiety scores were associated with an increased risk of dysregulation (OR = 1.131, 95% CI: 1.020–1.255). The effect of Type D personality score lost statistical significance in the second model. Table 4. Binary logistic regression results for predicting dysregulation (Regulated = 0, Dysregulated = 1) Model 1 Model 2 B OR 95% CI R² B OR 95% CI R² DS14 0.019 1.019 1.001-1.037 0.029 DS14 -0.031 0.969 0.937-1.003 0.313 DSMQ -0.648 0.523 0.422-0.649 HADS-Anxiety 0.123 1.131 1.020-1.255 HADS-Depression -0.087 0.916 0.818-1.026 B = unstandardized regression coefficient; OR = odds ratio; CI = confidence interval; R² = Nagelkerke R-squared HADS = Hospital Anxiety and Depression Scale; DS14 = Type D Personality Scale; DSMQ = Diabetes Self-Management Questionnaire As shown in Figure 1, diabetes self-management mediates the relationship between Type D personality and the general health subdimension of the SF-36. According to the results of the mediation analysis, Type D personality had a direct negative effect on general health (b = –0.878, p < 0.001). Furthermore, Type D personality indirectly weakened perceived general health by reducing diabetes self-management (b = –0.102, 95% CI: –0.201 to –0.014). These findings suggest that diabetes self-management may play a mediating role in the effect of Type D personality on health perception; that is, an increase in Type D personality traits may lead to poorer self-management, which in turn results in lower general health scores. No significant mediating effects were found for the other SF-36 subdimensions (Figure 1). Figure 2 illustrates the moderating role of Type D personality in the relationship between diabetes self-management scores and the emotional role limitation subdimension of the SF-36. The moderation effect was significant (R² = 0.355, p = 0.011). According to the moderation analysis, as self-management scores increased, emotional role limitations decreased, and this relationship was significant among individuals without Type D personality (95% CI: 1.268–7.431). In contrast, among individuals with Type D personality (+), the relationship between self-management and emotional role limitations was weak and nonsignificant (95% CI: –5.803 to 1.770). In Figure 2, the line representing the non–Type D group shows that higher self-management scores are associated with reduced emotional role limitations (a positive slope), whereas the line for the Type D positive group appears flat or slightly negative, indicating a weaker association (Figure 2). 4. Discussion In this study, the relationships among Type D personality traits, diabetes regulation, and quality of life in patients with T2DM were examined, and the roles of psychosocial factors in these relationships were explored. The main finding of the study is that patients with T2DM who exhibit Type D personality traits have a markedly lower quality of life. Low self-management levels and high anxiety scores were identified as key predictors of diabetes dysregulation. Furthermore, Type D personality was found to influence the general health subdimension of quality of life both directly and indirectly through diabetes self-management. The presence of a Type D personality also significantly weakened the positive relationship between self-management and the emotional role limitation subdimension of quality of life, demonstrating a moderating effect. Taken together, these findings suggest that in patients with T2DM, Type D personality may exert a significant negative influence on diabetes self-management and quality of life through both indirect and interactive pathways. This study underscores the importance of personality traits and psychological factors in diabetes control and highlights the need to incorporate a biopsychosocial approach into clinical practice. In this study, diabetes self-management and quality of life were significantly lower in the dysregulated T2DM group than in the other groups, whereas anxiety and depression levels were significantly greater. These results are consistent with the literature, indicating that the psychological burden increases among diabetic patients with poor metabolic control [25, 26]. This may be related to the impact of poor glycemic control on brain neurobiology or to the complications associated with diabetes [25]. On the other hand, previous studies have also shown that anxiety and depression themselves may contribute to poor glycemic control [27]. In light of these findings, we believe that it is important to consider psychosocial factors in diabetes management. Considering the bidirectional effect of mental well-being on glycemic control, we can say that psychological support is needed in addition to medical treatment to achieve proper blood glucose regulation. An important finding of this study was the markedly lower scores across all subdimensions of quality of life among diabetic patients with Type D personality. This result suggests that Type D personality may be a significant determinant of quality of life in individuals with diabetes. Consistent with our findings, previous studies have reported that diabetic patients with Type D personality traits have significantly lower quality of life scores in domains such as social relationships, daily life activities, sexual functioning, and physical mobility [9, 10]. Furthermore, the similarity of HbA1c levels between the two groups in our study indicates that the reduction in quality of life cannot be explained solely by glycemic control, suggesting that psychosocial factors may also independently contribute. Another finding of this study was the significant decrease observed across all subdimensions of diabetes self-management among diabetic patients with Type D personality. Consistent with our results, previous studies have reported that individuals with T2DM who exhibit Type D personality traits have significantly lower scores in all aspects of diabetes self-management, including diet, exercise, and medication adherence [28]. These data indicate that individuals with Type D personality traits may have impaired diabetes self-management behaviours and that patients with a Type D personality structure may experience difficulties in treatment adherence. Social inhibition and negative affectivity, which are frequently observed in this personality structure, may reduce an individual’s sense of self-efficacy and weaken self-management skills. One of the key findings of this study is that diabetes self-management and anxiety levels were the strongest predictors of diabetes regulation. In the first model, Type D personality significantly predicted diabetes dysregulation; however, when diabetes self-management and anxiety variables were included, this significance disappeared. These findings suggest that Type D personality may influence diabetes dysregulation indirectly through diabetes self-management and anxiety. In the literature, individuals with T2DM who exhibit Type D personality traits tend to have poorer diabetes self-care, higher anxiety levels, and worse glycemic control [12]. Some studies have demonstrated that Type D personality may negatively affect glycemic control through its impact on diabetes self-management [8] and anxiety [12]. However, research that evaluates these variables together and compares regulated and dysregulated groups remains quite limited. Taken together, these findings emphasize that in diabetes management, it is crucial to assess not only biological parameters but also an individual’s anxiety level and self-management ability. In this study, Type D personality was found to influence the general health subdimension of quality of life in patients with T2DM both directly and indirectly. It was demonstrated that Type D personality may negatively affect perceived general health by impairing diabetes self-management. In the literature, Type D personality has similarly been reported to deteriorate the quality of life of individuals with T2DM directly. Furthermore, in this patient group, Type D personality has been shown to worsen both quality of life and glycemic control through diabetes-related stress and social isolation [29]. Another study indicated that Type D personality could impair diabetes self-care through emotion-focused coping strategies [30]. Similarly, other research has emphasized that the negative effects of Type D personality in individuals with T2DM occur through low self-efficacy and poor self-care behaviors [12]. There are only a limited number of studies investigating the relationships among Type D personality, diabetes self-management, and quality of life. However, similar mechanisms have been explored in other chronic diseases. For example, in women with breast cancer, Type D personality was found to influence quality of life through treatment adherence [31]. In a cohort study of cardiac patients, the relationship between Type D personality and quality of life was mediated by anxiety, depression, and social support, and this effect remained stable over a 24-month follow-up period [32]. Taken together, these findings suggest that the impact of Type D personality on quality of life should not be regarded as a one-dimensional effect but rather as a multilayered psychosocial process. Our study contributes to the literature by explaining this relationship through a behavioral mechanism, namely diabetes self-management. One of the novel contributions of this study is the demonstration of the moderating effect of Type D personality. Type D personality had a significant moderating influence on the relationship between diabetes self-management and the emotional role limitation subdimension of quality of life. Specifically, increased diabetes self-management skills were associated with decreased emotional role limitations, but this relationship was statistically significant only among individuals without Type D personality. In contrast, among those with Type D personality, even higher self-management scores were not accompanied by notable improvements in emotional functioning. This suggests that core features of Type D personality, such as negative affectivity and social inhibition, may hinder the reflection of behavioral improvements in diabetes self-management in terms of emotional functioning. Individuals with Type D personality traits tend to evaluate their health more negatively and continue to internalize disease-related stress even when their metabolic status is relatively good. They often report more symptoms, greater functional impairment, and increased health-related complaints independent of their objective health condition [33, 34]. In a large-scale study involving cancer patients, emotional role limitations were found to be more pronounced among those with Type D personality, and this effect was independent of comorbid psychiatric problems [35]. Although there are no studies directly examining this relationship in diabetic populations, the literature indicates that individuals with type D diabetes perceive their health more negatively, internalize diabetes-related stress more strongly, and consequently experience greater emotional role limitations [7, 12]. A 2023 study also reported that Type D personality affected quality of life, including emotional role limitations, independently of glycemic control [10]. Taken together, these findings indicate that this is the first study to demonstrate the moderating role of Type D personality in the relationship between diabetes self-management and emotional functioning. Our findings show that Type D personality plays an active role in emotional adaptation processes as well as in disease management. This information suggests that in the presence of Type D personality, stress coping and emotional awareness should be added to the treatment process together with diabetes self-management. Most studies examining the relationships among Type D personality, diabetes regulation, and quality of life have been conducted with a limited number of psychological variables and have focused primarily on mediation models, independent of behavioral mechanisms. A substantial portion of these studies compared patients with T2DM to healthy controls but did not assess the psychosocial characteristics that vary according to the level of glycemic control. Our study contributes several novel insights to this area. Specifically, regulated and dysregulated T2DM patients were evaluated comparatively, revealing psychosocial and behavioral differences based on glycemic control status. In addition, the direct effects of Type D personality and quality of life were examined, while their indirect associations through diabetes self-management and anxiety levels were tested using structural models. Furthermore, the moderating role of Type D personality in the relationship between diabetes self-management and emotional role limitations was demonstrated. These findings show that Type D personality influences diabetes management through both indirect (mediational) and interactive (moderational) mechanisms. In this study, the specific effects of Type D personality on quality of life, particularly on general health and emotional functioning, in individuals with T2DM were evaluated in detail. Some important limitations of this study include its cross-sectional design, the use of self-report measures, the fact that the sample was collected from a single center, and the limited biochemical values examined. Furthermore, factors such as age, sex, socioeconomic status, and comorbidities were statistically controlled. However, confounding effects cannot be completely excluded. 5. Conclusion Our study examined the possible effects of Type D personality traits on diabetes control, self-management, and quality of life in individuals with T2DM. The roles of psychosocial factors in the relationships among these factors were also evaluated. According to the results of our study, the presence of a Type D personality in individuals with T2DM was associated with significantly lower quality of life. In addition, diabetes self-management was also significantly impaired in these individuals. In our study, the main determinants of diabetes regulation were high anxiety levels and weak self-management skills. Morever, Type D personality affects the quality of life of individuals with T2DM both directly and indirectly through diabetes self-management. In this study, Type D personality significantly weakened the positive relationship between diabetes self-management and the emotional dimension of quality of life. All these results highlight the importance of both personality traits and psychosocial factors in the management of T2DM. In future studies, longitudinal designs should be used to examine these relationships in terms of causality. In addition, the effects of psychosocial interventions to be applied to individuals with Type D personality traits on diabetes management and quality of life should be evaluated. Abbreviations T2DM Type 2 Diabetes Mellitus HADS Hospital Anxiety and Depression Scale DS14 Type D Personality Scale HbA1c Hemoglobin A1c DSMQ Diabetes Self-Management Questionnaire ANOVA Analysis of variance PROCESS Hayes’ PROCESS Macro for SPSS Declarations Ethics approval and consent to participate : This study was approved by the Ethics Committee of Giresun Training and Research Hospital (Decision No: 19.03.2025/12; Approval Date: 24.03.2025). All procedures were conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants. Data Availability Statement: Data are available from the corresponding author upon reasonable request. Consent for publication: Not applicable. Clinical trial number: not applicable Conflicts of Interest: The authors declare that they have no competing interests. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. 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J Affect Disord. 2012;136(1–2):26–34. https://doi.org/10.1016/j.jad.2011.08.034 Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1.SociodemographicandClinicalDataFormEnglishVersion.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 09 Jan, 2026 Reviewers agreed at journal 05 Jan, 2026 Reviews received at journal 24 Dec, 2025 Reviewers agreed at journal 03 Dec, 2025 Reviewers invited by journal 30 Nov, 2025 Editor assigned by journal 30 Nov, 2025 Editor invited by journal 27 Nov, 2025 Submission checks completed at journal 26 Nov, 2025 First submitted to journal 26 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":69383,"visible":true,"origin":"","legend":"\u003cp\u003eThe mediating role of diabetes self-management in the relationship between Type D personality and general health.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8181318/v1/629ec9dd4552d157d7243594.png"},{"id":97368515,"identity":"cf92d7e2-2fb5-4134-9fc7-6eb0094c4070","added_by":"auto","created_at":"2025-12-03 16:22:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":54228,"visible":true,"origin":"","legend":"\u003cp\u003eModerating effect of Type D personality on the relationship between diabetes self-management and emotional role limitations.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8181318/v1/afe3a47211f52d349f495822.png"},{"id":97664535,"identity":"b8485a8b-d04a-4c02-b925-a11385329fbd","added_by":"auto","created_at":"2025-12-08 09:09:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1647789,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8181318/v1/d111d2ac-85d8-49c5-bfcb-39bdbd9c7951.pdf"},{"id":97271868,"identity":"3b237884-9b05-4ee0-ab57-7d595759439e","added_by":"auto","created_at":"2025-12-02 15:04:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":129665,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.SociodemographicandClinicalDataFormEnglishVersion.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8181318/v1/61cf4121872ed04c1c628637.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Type D Personality and Diabetes Self-Management in Type 2 Diabetes: A Mediation–Moderation Model on Glycemic Control and Quality of Life","fulltext":[{"header":"Highlights","content":"\u003cp\u003e\u0026bull; Type D personality is associated with poorer glycemic control in patients with Type 2 diabetes\u003c/p\u003e\u003cp\u003e\u0026bull; Type D is associated with poorer diabetes self-management and lower quality of life\u003c/p\u003e\u003cp\u003e\u0026bull; High anxiety and impaired self-management are key predictors of poor glycemic control\u003c/p\u003e\u003cp\u003e\u0026bull; Diabetes self-management mediates the negative effect of Type D personality on perceived general health\u003c/p\u003e\u003cp\u003e\u0026bull; Type D personality moderates the relationship between diabetes self-management and emotional role limitations\u003c/p\u003e"},{"header":"1. Background","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eTip 2 diyabetes mellitus (T2DM) is a chronic metabolic disease that is a major public health problem worldwild. Reports from 2021 revealed that approximately 508\u0026nbsp;million people were diagnosed with T2DM [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. People with T2DM should be able to control their blood sugar levels well. If T2DM is not well managed, it can lead to serious problems. People's quality of life may decrease substantially, and their health costs may increase. A significant proportion of patients diagnosed with T2DM cannot achieve the desired regulation despite effective pharmacological treatments [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Therefore, in addition to pharmacological approaches, diabetes self-management, including medication adherence, nutrition, and exercise, should also be considered in the control of the disease.\u003c/p\u003e\u003cp\u003ePsychosocial factors also play a significant role in the possible outcomes of T2DM. Studies have shown that 25\u0026ndash;55% of individuals with T2DM experience moderate to severe psychological distress, such as anxiety, depression, and stress [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These psychological difficulties are both a consequence of having T2DM and factors that negatively influence the course of the disease. They impair adherence to diet, exercise, and treatment among individuals with T2DM. Moreover, they reduce social participation, adversely affect glycemic control, and decrease quality of life [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, thoroughly understanding the psychosocial characteristics that disrupt diabetes self-management and negatively influence diabetes regulation is highly important.\u003c/p\u003e\u003cp\u003ePersonality traits can influence the regulation of T2DM. In recent years, the relationship between diabetes and Type D personality traits has attracted increasing attention. A type D personality is a personality pattern characterized by the coexistence of negative affectivity and social inhibition. Individuals with Type D personalities report higher levels of psychological distress, hopelessness, and social isolation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This condition particularly affects health behaviors and physiological stress responses in a negative manner. Furthermore, Type D personality makes coping with illnesses more difficult, reduces social support, and therefore adversely affects medical prognosis [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This personality pattern has been recognized as an autonomous risk factor for negative outcomes in several chronic diseases, including cardiovascular disorders and diabetes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRecent studies have reported that Type D personality is prevalent among patients with diabetes and that it complicates disease management [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In individuals with T2DM, Type D personality is associated with poor medication adherence, inadequate self-care, and unhealthy lifestyle behaviors [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Furthermore, it has been demonstrated that patients with T2DM who possess Type D personality traits have significantly lower quality of life [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This personality structure markedly increases levels of diabetes-related stress, anxiety, and depression. These psychosocial factors, in turn, play a mediating role in the deterioration of quality of life among individuals with [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the literature, a consistent and positive relationship has been identified between diabetes self-management and quality of life among patients with T2DM [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Numerous studies have also reported that diabetes self-management is impaired in patients with T2DM who exhibit Type D personality traits [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, few studies have investigated how Type D personality characteristics indirectly affect quality of life through diabetes self-management in individuals with T2DM.\u003c/p\u003e\u003cp\u003eThe literature indicates that Type D personality and psychosocial factors may be associated with poor glycemic control. However, studies that systematically compare T2DM patients with good and poor glycemic control, that is, different patient subgroups, in terms of Type D personality traits and psychosocial factors are limited. Moreover, comparing these subgroups with healthy controls may provide important insights into whether the observed differences are specific to diabetes.\u003c/p\u003e\u003cp\u003eIn this study, we sought to examine the impact of Type D personality traits on diabetes regulation and self-management, along with their correlation with quality of life in individuals diagnosed with T2DM.\u003c/p\u003e\u003cp\u003eThis study's hypotheses are as follows:\u003c/p\u003e\u003cp\u003eH1: The frequency of Type D personality traits is greater in the dysregulated T2DM group than in the regulated T2DM group and healthy controls.\u003c/p\u003e\u003cp\u003eH2: T2DM patients with Type D personality traits exhibit lower self-management skills.\u003c/p\u003e\u003cp\u003eH3: Type D personality moderates the relationship between diabetes self-management and quality of life.\u003c/p\u003e\u003cp\u003eH4: In patients with T2DM, Type D personality is positively associated with levels of anxiety and depression.\u003c/p\u003e\u003cp\u003eH5: There is an indirect effect between Type D personality and quality of life through diabetes self-management.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Study Design and Sample\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis study was conducted with a cross-sectional and comparative design. The sample size was determined via the G*Power program, with a Type I error rate of 5%, a statistical power of 95%, and a medium effect size (0.25). On the basis of on these parameters, the minimum required number of participants for each group was calculated to be 84 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA total of 210 patients aged between 30 and 75 years who were diagnosed with T2DM and were referred to the Internal Medicine outpatient clinics of Giresun Training and Research Hospital were included in the study. The diagnosis of diabetes was based on medical records confirmed by an internal medicine specialist, in accordance with the criteria of the Turkish Society of Endocrinology and Metabolism\u0026rsquo;s Guidelines for the Diagnosis, Treatment, and Follow-up of Diabetes Mellitus and Its Complications (2024), which define T2DM as hemoglobin A1c (HbA1c)\u0026thinsp;\u0026ge;\u0026thinsp;6.5%(48 mmol/mol) or fasting plasma glucose\u0026thinsp;\u0026ge;\u0026thinsp;126 mg/Dl (7.0 mmol/L) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The group with regulated diabetes was determined on the basis of blood samples taken on the day of inclusion in the study, according to the following criteria: HbA1c\u0026thinsp;\u0026le;\u0026thinsp;7%(53 mmol/mol), fasting blood glucose between 80\u0026ndash;130 mg/dL(4.4\u0026ndash;7.2 mmol/L), postprandial blood glucose\u0026thinsp;\u0026lt;\u0026thinsp;180 mg/dL(10.0 mmol/L), and absence of hypoglycemia [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Those who did not meet these criteria were classified as having dysregulated T2DM. The healthy control group consisted of individuals without any psychiatric or diabetes diagnosis. This group was selected to have characteristics similar to those of the study group in terms of age and sex. The purpose of the study was explained to all three groups, and written informed consent was obtained.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Exclusion criteria\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe exclusion criteria for this study included the presence of type 1 diabetes, gestational diabetes, or secondary diabetes. In addition, individuals with acute diabetes-related complications or a history of severe hypoglycemia were excluded from the study. Other exclusion criteria were as follows: cognitive impairment that could prevent completion of the scales; the presence of severe neurological diseases; the presence of active malignancy; the presence of advanced comorbid physical diseases; the presence of an active psychiatric disorder; pregnancy and lactation; and the presence of an acute infection.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Data collection instruments\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA sociodemographic and clinical data form specifically developed for this study was used to collect descriptive information. The form included items on age, sex, marital status, education level, disease duration, current diabetes treatment, comorbidities, and smoking history. In addition, laboratory measurements obtained on the day of study enrollment (HbA1c, fasting glucose, and postprandial glucose) were recorded using this form.\u003c/p\u003e\u003cp\u003eThe English version of the form, developed by the research team, is provided as Supplementary File 1.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDiabetes Self-Management Questionnaire (DSMQ)\u003c/b\u003e: This self-report scale was developed to assess the level of active participation of individuals with diabetes in managing their disease and self-care. The scale was initially developed by Schmitt et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and its Turkish validity and reliability studies were conducted by Eroğlu and Sabuncu [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The DSMQ consists of 16 items grouped into four subscales: glucose management, dietary control, physical activity, and health-care use. It is a 4-point Likert-type scale, with items rated from 0 to 3. Higher scores indicate better diabetes self-management. In the Turkish adaptation study, the Cronbach\u0026rsquo;s alpha coefficient of the scale was reported as 0.85, and the intraclass correlation coefficients for the subscales ranged between 0.97 and 0.99.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHospital Anxiety and Depression Scale (HADS)\u003c/strong\u003e\u003cp\u003eThis self-report scale was developed by Snaith [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] to assess symptoms of anxiety and depression in individuals. It was specifically designed to distinguish psychological symptoms that accompany physical illnesses. The scale consists of 14 items, of which 7 assess anxiety and 7 assess depression. Each item is rated on a 4-point scale ranging from 0 to 3, with each subscale yielding a total score between 0 and 21. A Turkish validity and reliability study was conducted by Aydemir et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In that study, the Cronbach\u0026rsquo;s alpha coefficient was 0.8525 for the anxiety subscale and 0.7784 for the depression subscale. The test\u0026ndash;retest reliability coefficient was 0.7618 for anxiety and 0.8069 for depression. Factor analysis confirmed a two-factor structure corresponding to anxiety and depression.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eType D Personality Scale (DS14)\u003c/strong\u003e\u003cp\u003eThis scale was developed by Denollet. It assesses individuals\u0026rsquo; levels of negative affectivity (NA) and social inhibition (SI) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The scale consists of two subdimensions, each containing 7 items, for a total of 14 items. The participants evaluate each item on a 5-point Likert scale (0\u0026thinsp;=\u0026thinsp;false, 4\u0026thinsp;=\u0026thinsp;true). A score of \u0026ge;\u0026thinsp;10 on each subdimension indicates that the individual has a Type D personality trait. The Turkish validity and reliability study was conducted by \u0026Ouml;nc\u0026uuml; et al. (2018) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. For this scale, the Cronbach\u0026rsquo;s alpha coefficient was 0.85 for negative affectivity and 0.76 for social inhibition, while the test\u0026ndash;retest correlation coefficient was 0.75/0.77.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eShort Form-36 Quality of Life Scale (SF-36)\u003c/strong\u003e\u003cp\u003eThis self-report instrument, developed by Ware and Sherbourne [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], evaluates individuals\u0026rsquo; quality of life across eight dimensions. These dimensions include physical functioning, social functioning, role limitations due to physical problems, role limitations due to emotional problems, mental health, pain, vitality, and general health perceptions. The scale consists of 36 items, each scored from 0 to 100, with higher scores indicating better quality of life. A Turkish validity and reliability study was conducted by Ko\u0026ccedil;yiğit et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In that study, the Cronbach\u0026rsquo;s alpha coefficients for the subscales ranged between 0.73 and 0.76, and the item\u0026ndash;total correlations varied from 0.47 to 0.88. Additionally, the scale demonstrated significant correlations with the Nottingham Health Profile, ranging from 0.44 to 0.65. These findings indicate that the Turkish version of the SF-36 is a valid, reliable instrument with high internal consistency.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e2.4. Ethical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Giresun Training and Research Hospital (Decision No: [19.03.2025/12], Date: [24.03.2025]). Written informed consent was obtained from all participants. The study was conducted in accordance with the principles of the Declaration of Helsinki (2013).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5. Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were analyzed via SPSS version 27. The normality assumption for continuous variables was assessed by examining skewness and kurtosis values within the \u0026plusmn;1.5 range [23]. For variables with a normal distribution, independent samples t-tests and one-way ANOVA were applied, whereas for nonnormally distributed variables, Mann\u0026ndash;Whitney U and Kruskal\u0026ndash;Wallis H tests were used. Differences between categorical variables were examined via the chi-square test. To control for confounding variables that differed between groups, MANCOVA models were constructed. When significant differences were found among groups, Tukey, Games\u0026ndash;Howell, or Bonferroni-adjusted post-hoc analyses were performed. To determine the predictors of dysregulation, binary logistic regression analysis was conducted, and the results are reported as odds ratios (ORs) with 95% confidence intervals (CIs). In addition, the SPSS PROCESS macro [24] was used to examine the relationships among psychosocial variables. Within this framework:\u003c/p\u003e\n\u003cp\u003e\u0026bull;\u0026nbsp; \u0026nbsp;\u0026nbsp;Using Model 4, the mediating role of diabetes self-management in the relationship between Type D personality and quality of life dimensions was tested.\u003c/p\u003e\n\u003cp\u003e\u0026bull;\u0026nbsp; \u0026nbsp;\u0026nbsp;Model 1 was used to evaluate the moderating role of Type D personality in the effect of diabetes self-management on quality of life.\u003c/p\u003e\n\u003cp\u003eA significance level of p \u0026lt; 0.05 was accepted for all analyses.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eAge and years of education were similar across groups, with no statistically significant differences. The sex distribution was balanced among all three groups. No significant group differences were observed in income level or place of residence. Similarly, there were no significant differences between the groups in terms of psychiatric history, smoking status, or alcohol use. The proportion of participants with comorbid conditions was highest in the dysregulated group (80.2%), followed by the regulated group (69.7%) and the control group (53.7%), and this difference was statistically significant. Table 1 presents the distribution of participants\u0026rsquo; sociodemographic characteristics by group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eDistribution of participants\u0026rsquo; sociodemographic characteristics by group\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD, Median (Q1-Q3), n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegulated DM\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 109)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDysregulated DM (n = 101)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthy Control (n =108)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e60 (53-65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e60 (52.5-64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e59 (46.5-63.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eH = 2.894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.235\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.06 \u0026plusmn; 4.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6.71 \u0026plusmn; 4.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e7.81 \u0026plusmn; 3.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eF = 1.817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eX\u0026sup2; = 0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.627\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e58 (53.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e47 (46.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e54 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e51 (46.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e54 (53.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e54 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eX\u0026sup2; = 5.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.280\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026le;1 minimum wage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e64 (58.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e69 (68.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e60 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e2 minimum wages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e26 (23.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e22 (21.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e27 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026ge;3 minimum wages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e19 (17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e10 (9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e21 (19.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eX\u0026sup2; = 5.790\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eUrban\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e54 (49.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e38 (37.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e58 (53.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e55 (50.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e63 (62.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e50 (46.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbid disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eX\u0026sup2; = 17.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e33 (30.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e20 (19.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e50 (46.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e76 (69.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e81 (80.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e58 (53.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychiatric history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eX\u0026sup2; = 1.338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e29 (26.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e26 (25.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e22 (20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e80 (73.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e75 (74.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e86 (79.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily history of DM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eX\u0026sup2; = 18.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e57 (52.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e69 (68.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e42 (38.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e52 (47.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e32 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e66 (61.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eX\u0026sup2; = 0.573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.751\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eSmoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e33 (30.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e35 (34.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e33 (30.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNon-smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e76 (69.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e66 (65.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e75 (69.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eX\u0026sup2; = 5.658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eUser\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e15 (13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e12 (11.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e25 (23.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNon-user\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e94 (86.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e89 (88.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e83 (76.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 690px;\"\u003e\n \u003cp\u003en = sample size; p = statistical significance level; Q1 = first quartile; Q3 = third quartile; SD = standard deviation; F = ANOVA test statistic; H = Kruskal\u0026ndash;Wallis H test statistic; X\u0026sup2; = chi-square test statistic\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDM = diabetes mellitus.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 presents the clinical indicators of T2DM along with measures of diabetes self-management, psychological status, quality of life, and Type D personality traits. The duration of diabetes diagnosis did not differ significantly between the two patient groups. The total DSMQ score and its subscales were higher in the regulated group and markedly lower in the dysregulated group. For the HADS subscales, anxiety and depression scores were highest in the dysregulated group, lowest in the healthy control group, and intermediate in the regulated group. With respect to the SF-36 subscales, particularly physical functioning, role limitations due to physical and emotional problems, vitality, mental health, social functioning, pain, and general health, the control group had the highest scores, whereas the dysregulated group had the lowest scores. The regulated group ranked between the two. When the total score and components of the Type D Personality Scale were examined, both diabetes groups presented higher scores than did the healthy control group, with the dysregulated group having the highest scores, followed by the regulated and control groups. The proportion of participants classified as Type D positive also differed among the groups, with the prevalence ranking as follows: Dysregulated \u0026ge; Regulated \u0026ge; Control.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 690px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2. Comparison of clinical characteristics, self-management, psychological status, quality of life, and Type D personality measures among groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD, Median (Q1-Q3), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegulated DM\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 109)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDysregulated DM (n = 101)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthy Control (n =108)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistic\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost hoc\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of DM diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6.28 \u0026plusmn; 4.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.52 \u0026plusmn; 5.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003et = -1.902\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDSMQ (Total)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6.25 \u0026plusmn; 1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4.39 \u0026plusmn; 1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eF = 53.785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eGlucose management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6.74 \u0026plusmn; 2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4.93 \u0026plusmn; 2.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eF = 37.837\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eDietary control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5.90 \u0026plusmn; 2.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3.77 \u0026plusmn; 2.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eF = 52.400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePhysical activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4.92 \u0026plusmn; 2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3.40 \u0026plusmn; 2.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eF = 17.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eHealth-care use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7.14 \u0026plusmn; 2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5.27 \u0026plusmn; 2.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eF = 35.934\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHADS-Anxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7.06 \u0026plusmn; 4.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.12 \u0026plusmn; 5.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5.11 \u0026plusmn; 3.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eF = 14.981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eD \u0026gt; R \u0026gt; C\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHADS-Depression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7.39 \u0026plusmn; 4.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.67 \u0026plusmn; 4.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4.19 \u0026plusmn; 3.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eF = 21.825\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eD = R \u0026gt; C\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 Physical functioning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e75 (45-90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e60 (42.50-85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e90 (75-95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eH = 52.470\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eC \u0026gt; R = D\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 Role limitations (physical)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e51.61 \u0026plusmn; 35.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e42.82 \u0026plusmn; 36.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e65.74 \u0026plusmn; 33.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eF = 9.432\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eC \u0026ge; R \u0026ge; D\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 Role limitations (emotional)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e66.67 (0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e33.33 (0-66.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e66.67 (33.33-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eH = 22.334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eC \u0026gt; R = D\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 Vitality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e52.11 \u0026plusmn; 23.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e46.83 \u0026plusmn; 24.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e60.83 \u0026plusmn; 18.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eF = 7.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eC \u0026ge; R \u0026ge; D\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 Mental health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e58.90 \u0026plusmn; 20.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e55.09 \u0026plusmn; 20.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e64.41 \u0026plusmn; 17.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eF = 3.598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eC \u0026ge; R \u0026ge; D\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 Social functioning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e60.67 \u0026plusmn; 22.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e53.87 \u0026plusmn; 26.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e74.77 \u0026plusmn; 20.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eF = 15.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eC \u0026gt; R = D\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 Pain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e56.40 \u0026plusmn; 27.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e54.28 \u0026plusmn; 27.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e73.80 \u0026plusmn; 22.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eF = 14.757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eC \u0026gt; R = D\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 General health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e49.13 \u0026plusmn; 21.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e42.20 \u0026plusmn; 21.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e65.09 \u0026plusmn; 17.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eF = 25.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eC \u0026gt; R = D\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDS14 (Total)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e20.86 \u0026plusmn; 15.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e25.50 \u0026plusmn; 15.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e16.28 \u0026plusmn; 13.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eF = 7.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eD \u0026ge; R \u0026ge; C\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNegative affectivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8 (3-20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e17 (4-22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5 (2-17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eH = 19.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eD = R \u0026gt; C\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSocial inhibition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e9.31 \u0026plusmn; 7.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e11.45 \u0026plusmn; 7.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7.36 \u0026plusmn; 6.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eF = 7.465\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eD \u0026ge; R \u0026ge; C\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType D personality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eX\u0026sup2; = 10.347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eD \u0026ge; R \u0026ge; C\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eType D (\u0026ndash;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e62 (56.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e46 (45.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e73 (67.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eType D (+)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e47 (43.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e55 (54.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e35 (32.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 690px;\"\u003e\n \u003cp\u003en = sample size; p = statistical significance level; Q1 = first quartile; Q3 = third quartile; SD = standard deviation; F = MANCOVA test statistic (controlled for the presence of comorbid diseases); H = Kruskal\u0026ndash;Wallis H test statistic; t = t-test statistic; X\u0026sup2; = chi-square test statistic\u003c/p\u003e\n \u003cp\u003eDM = diabetes mellitus; D = dysregulated DM; R = regulated DM; C = healthy control; HADS = Hospital Anxiety and Depression Scale; DS14 = Type D Personality Scale; SF-36 = Short Form-36; DSMQ = Diabetes Self-Management Questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn Table 3, diabetic patients were divided into two groups on the basis of the presence or absence of Type D personality traits and compared accordingly. HbA1c levels did not differ significantly between the Type D-positive and Type D-negative groups. However, there were marked differences in psychological status and quality of life parameters between the two groups. Patients with Type D personality traits had significantly higher HADS-Anxiety and HADS-Depression scores. For all subdimensions of the SF-36, the scores of the Type D positive group were significantly lower. Similarly, diabetes self-management and all of its subscales were also lower among individuals with Type D personality.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 671px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3. Comparison of diabetic patients by Type D personality characteristics in terms of clinical and psychosocial characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD, Median (Q1-Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType D (-)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 108)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType D (+)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 102)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistic\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHbA1c\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e7.70 \u0026plusmn; 2.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e8.06 \u0026plusmn; 2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003et = -1.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.238\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHADS-Anxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4 (3-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e11 (8-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eZ = -8.933\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHADS-Depression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4.87 \u0026plusmn; 3.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e11.32 \u0026plusmn; 3.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003et = -13.353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 Physical functioning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e85 (75-93.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e45 (28.75-56.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eZ = -9.442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 Role limitations (physical)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e67.36 \u0026plusmn; 30.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e26.23 \u0026plusmn; 28.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003et = 10.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 Role limitations (emotional)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e70.37 \u0026plusmn; 30.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e25.82 \u0026plusmn; 33.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003et = 10.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 Vitality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e65.42 \u0026plusmn; 17.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e32.79 \u0026plusmn; 18.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003et = 13.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 Mental health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e70.22 \u0026plusmn; 15.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e43.14 \u0026plusmn; 15.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003et = 12.782\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 Social functioning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e71.44 \u0026plusmn; 30.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e42.52 \u0026plusmn; 20.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003et = 10.385\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 Pain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e67.04 \u0026plusmn; 25.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e43.04 \u0026plusmn; 23.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003et = 7.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSF-36 General health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e59.02 \u0026plusmn; 19.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e31.96 \u0026plusmn; 15.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003et = 11.289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDSMQ (Total)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e6.32 \u0026plusmn; 1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4.34 \u0026plusmn; 1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003et = 7.951\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eGlucose management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e6.80 \u0026plusmn; 2.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4.89 \u0026plusmn; 2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003et = 6.554\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eDietary control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5.88 \u0026plusmn; 2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3.82 \u0026plusmn; 2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003et = 6.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003ePhysical activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5.29 \u0026plusmn; 2.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3.04 \u0026plusmn; 2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003et = 6.409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eHealth-care use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e7.08 \u0026plusmn; 2.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5.35 \u0026plusmn; 2.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003et = 5.492\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 671px;\"\u003e\n \u003cp\u003en = sample size; p = statistical significance level; Q1 = first quartile; Q3 = third quartile; SD = standard deviation; t = t-test statistic; Z = Mann\u0026ndash;Whitney U test statistic\u003c/p\u003e\n \u003cp\u003eDM = diabetes mellitus; HADS = Hospital Anxiety and Depression Scale; SF-36 = Short Form-36; DSMQ = Diabetes Self-Management Questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA binary logistic regression analysis was conducted to identify the factors distinguishing regulated (coded 0) and dysregulated (coded 1) diabetic patients (Table 4). In the first model, only the Type D Personality Scale (DS14) total score was included. Each one-point increase in DS14 was associated with a 1.9% greater likelihood of being dysregulated (OR = 1.019, 95% CI: 1.001\u0026ndash;1.037). The DSMQ, HADS-Anxiety, and HADS-Depression scores were subsequently added to the model. In this extended model, each one-point increase in DSMQ score was associated with an approximately 50% reduction in the odds of being dysregulated (OR = 0.523, 95% CI: 0.422\u0026ndash;0.649), whereas higher HADS-Anxiety scores were associated with an increased risk of dysregulation (OR = 1.131, 95% CI: 1.020\u0026ndash;1.255). The effect of Type D personality score lost statistical significance in the second model.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"641\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 641px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4. Binary logistic regression results for predicting dysregulation (Regulated = 0, Dysregulated = 1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 1\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eR\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eR\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDS14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1.001-1.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDS14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.969\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.937-1.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.313\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDSMQ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-0.648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.523\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.422-0.649\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHADS-Anxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1.020-1.255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHADS-Depression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.916\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.818-1.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 641px;\"\u003e\n \u003cp\u003eB = unstandardized regression coefficient; OR = odds ratio; CI = confidence interval; R\u0026sup2; = Nagelkerke R-squared\u003c/p\u003e\n \u003cp\u003eHADS = Hospital Anxiety and Depression Scale; DS14 = Type D Personality Scale; DSMQ = Diabetes Self-Management Questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs shown in Figure 1, diabetes self-management mediates the relationship between Type D personality and the general health subdimension of the SF-36. According to the results of the mediation analysis, Type D personality had a direct negative effect on general health (b = \u0026ndash;0.878, p \u0026lt; 0.001). Furthermore, Type D personality indirectly weakened perceived general health by reducing diabetes self-management (b = \u0026ndash;0.102, 95% CI: \u0026ndash;0.201 to \u0026ndash;0.014). These findings suggest that diabetes self-management may play a mediating role in the effect of Type D personality on health perception; that is, an increase in Type D personality traits may lead to poorer self-management, which in turn results in lower general health scores. No significant mediating effects were found for the other SF-36 subdimensions (Figure 1).\u003c/p\u003e\n\u003cp\u003eFigure 2 illustrates the moderating role of Type D personality in the relationship between diabetes self-management scores and the emotional role limitation subdimension of the SF-36. The moderation effect was significant (R\u0026sup2; = 0.355, p = 0.011). According to the moderation analysis, as self-management scores increased, emotional role limitations decreased, and this relationship was significant among individuals without Type D personality (95% CI: 1.268\u0026ndash;7.431). In contrast, among individuals with Type D personality (+), the relationship between self-management and emotional role limitations was weak and nonsignificant (95% CI: \u0026ndash;5.803 to 1.770). In Figure 2, the line representing the non\u0026ndash;Type D group shows that higher self-management scores are associated with reduced emotional role limitations (a positive slope), whereas the line for the Type D positive group appears flat or slightly negative, indicating a weaker association (Figure 2).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this study, the relationships among Type D personality traits, diabetes regulation, and quality of life in patients with T2DM were examined, and the roles of psychosocial factors in these relationships were explored. The main finding of the study is that patients with T2DM who exhibit Type D personality traits have a markedly lower quality of life. Low self-management levels and high anxiety scores were identified as key predictors of diabetes dysregulation. Furthermore, Type D personality was found to influence the general health subdimension of quality of life both directly and indirectly through diabetes self-management. The presence of a Type D personality also significantly weakened the positive relationship between self-management and the emotional role limitation subdimension of quality of life, demonstrating a moderating effect. Taken together, these findings suggest that in patients with T2DM, Type D personality may exert a significant negative influence on diabetes self-management and quality of life through both indirect and interactive pathways. This study underscores the importance of personality traits and psychological factors in diabetes control and highlights the need to incorporate a biopsychosocial approach into clinical practice.\u003c/p\u003e\n\u003cp\u003eIn this study, diabetes self-management and quality of life were significantly lower in the dysregulated T2DM group than in the other groups, whereas anxiety and depression levels were significantly greater. These results are consistent with the literature, indicating that the psychological burden increases among diabetic patients with poor metabolic control [25, 26]. This may be related to the impact of poor glycemic control on brain neurobiology or to the complications associated with diabetes [25]. On the other hand, previous studies have also shown that anxiety and depression themselves may contribute to poor glycemic control [27]. In light of these findings, we believe that it is important to consider psychosocial factors in diabetes management. Considering the bidirectional effect of mental well-being on glycemic control, we can say that psychological support is needed in addition to medical treatment to achieve proper blood glucose regulation.\u003c/p\u003e\n\u003cp\u003eAn important finding of this study was the markedly lower scores across all subdimensions of quality of life among diabetic patients with Type D personality. This result suggests that Type D personality may be a significant determinant of quality of life in individuals with diabetes. Consistent with our findings, previous studies have reported that diabetic patients with Type D personality traits have significantly lower quality of life scores in domains such as social relationships, daily life activities, sexual functioning, and physical mobility [9, 10]. \u0026nbsp;Furthermore, the similarity of HbA1c levels between the two groups in our study indicates that the reduction in quality of life cannot be explained solely by glycemic control, suggesting that psychosocial factors may also independently contribute.\u003c/p\u003e\n\u003cp\u003eAnother finding of this study was the significant decrease observed across all subdimensions of diabetes self-management among diabetic patients with Type D personality. Consistent with our results, previous studies have reported that individuals with T2DM who exhibit Type D personality traits have significantly lower scores in all aspects of diabetes self-management, including diet, exercise, and medication adherence [28]. These data indicate that individuals with Type D personality traits may have impaired diabetes self-management behaviours and that patients with a Type D personality structure may experience difficulties in treatment adherence. Social inhibition and negative affectivity, which are frequently observed in this personality structure, may reduce an individual\u0026rsquo;s sense of self-efficacy and weaken self-management skills.\u003c/p\u003e\n\u003cp\u003eOne of the key findings of this study is that diabetes self-management and anxiety levels were the strongest predictors of diabetes regulation. In the first model, Type D personality significantly predicted diabetes dysregulation; however, when diabetes self-management and anxiety variables were included, this significance disappeared. These findings suggest that Type D personality may influence diabetes dysregulation indirectly through diabetes self-management and anxiety. In the literature, individuals with T2DM who exhibit Type D personality traits tend to have poorer diabetes self-care, higher anxiety levels, and worse glycemic control [12]. Some studies have demonstrated that Type D personality may negatively affect glycemic control through its impact on diabetes self-management [8] and anxiety [12]. However, research that evaluates these variables together and compares regulated and dysregulated groups remains quite limited. Taken together, these findings emphasize that in diabetes management, it is crucial to assess not only biological parameters but also an individual\u0026rsquo;s anxiety level and self-management ability.\u003c/p\u003e\n\u003cp\u003eIn this study, Type D personality was found to influence the general health subdimension of quality of life in patients with T2DM both directly and indirectly. It was demonstrated that Type D personality may negatively affect perceived general health by impairing diabetes self-management. In the literature, Type D personality has similarly been reported to deteriorate the quality of life of individuals with T2DM directly. Furthermore, in this patient group, Type D personality has been shown to worsen both quality of life and glycemic control through diabetes-related stress and social isolation [29]. Another study indicated that Type D personality could impair diabetes self-care through emotion-focused coping strategies [30]. Similarly, other research has emphasized that the negative effects of Type D personality in individuals with T2DM occur through low self-efficacy and poor self-care behaviors [12]. There are only a limited number of studies investigating the relationships among Type D personality, diabetes self-management, and quality of life. However, similar mechanisms have been explored in other chronic diseases. For example, in women with breast cancer, Type D personality was found to influence quality of life through treatment adherence [31]. In a cohort study of cardiac patients, the relationship between Type D personality and quality of life was mediated by anxiety, depression, and social support, and this effect remained stable over a 24-month follow-up period [32]. Taken together, these findings suggest that the impact of Type D personality on quality of life should not be regarded as a one-dimensional effect but rather as a multilayered psychosocial process. Our study contributes to the literature by explaining this relationship through a behavioral mechanism, namely diabetes self-management.\u003c/p\u003e\n\u003cp\u003eOne of the novel contributions of this study is the demonstration of the moderating effect of Type D personality. Type D personality had a significant moderating influence on the relationship between diabetes self-management and the emotional role limitation subdimension of quality of life. Specifically, increased diabetes self-management skills were associated with decreased emotional role limitations, but this relationship was statistically significant only among individuals without Type D personality. In contrast, among those with Type D personality, even higher self-management scores were not accompanied by notable improvements in emotional functioning. This suggests that core features of Type D personality, such as negative affectivity and social inhibition, may hinder the reflection of behavioral improvements in diabetes self-management in terms of emotional functioning. Individuals with Type D personality traits tend to evaluate their health more negatively and continue to internalize disease-related stress even when their metabolic status is relatively good. They often report more symptoms, greater functional impairment, and increased health-related complaints independent of their objective health condition [33, 34]. In a large-scale study involving cancer patients, emotional role limitations were found to be more pronounced among those with Type D personality, and this effect was independent of comorbid psychiatric problems [35]. Although there are no studies directly examining this relationship in diabetic populations, the literature indicates that individuals with type D diabetes perceive their health more negatively, internalize diabetes-related stress more strongly, and consequently experience greater emotional role limitations [7, 12]. A 2023 study also reported that Type D personality affected quality of life, including emotional role limitations, independently of glycemic control [10]. Taken together, these findings indicate that this is the first study to demonstrate the moderating role of Type D personality in the relationship between diabetes self-management and emotional functioning. Our findings show that Type D personality plays an active role in emotional adaptation processes as well as in disease management. This information suggests that in the presence of Type D personality, stress coping and emotional awareness should be added to the treatment process together with diabetes self-management.\u003c/p\u003e\n\u003cp\u003eMost studies examining the relationships among Type D personality, diabetes regulation, and quality of life have been conducted with a limited number of psychological variables and have focused primarily on mediation models, independent of behavioral mechanisms. A substantial portion of these studies compared patients with T2DM to healthy controls but did not assess the psychosocial characteristics that vary according to the level of glycemic control. Our study contributes several novel insights to this area. Specifically, regulated and dysregulated T2DM patients were evaluated comparatively, revealing psychosocial and behavioral differences based on glycemic control status. In addition, the direct effects of Type D personality and quality of life were examined, while their indirect associations through diabetes self-management and anxiety levels were tested using structural models. Furthermore, the moderating role of Type D personality in the relationship between diabetes self-management and emotional role limitations was demonstrated. These findings show that Type D personality influences diabetes management through both indirect (mediational) and interactive (moderational) mechanisms. In this study, the specific effects of Type D personality on quality of life, particularly on general health and emotional functioning, in individuals with T2DM were evaluated in detail.\u003c/p\u003e\n\u003cp\u003eSome important limitations of this study include its cross-sectional design, the use of self-report measures, the fact that the sample was collected from a single center, and the limited biochemical values examined. Furthermore, factors such as age, sex, socioeconomic status, and comorbidities were statistically controlled. However, confounding effects cannot be completely excluded.\u0026nbsp;\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eOur study examined the possible effects of Type D personality traits on diabetes control, self-management, and quality of life in individuals with T2DM. The roles of psychosocial factors in the relationships among these factors were also evaluated. According to the results of our study, the presence of a Type D personality in individuals with T2DM was associated with significantly lower quality of life. In addition, diabetes self-management was also significantly impaired in these individuals. In our study, the main determinants of diabetes regulation were high anxiety levels and weak self-management skills. Morever, Type D personality affects the quality of life of individuals with T2DM both directly and indirectly through diabetes self-management. In this study, Type D personality significantly weakened the positive relationship between diabetes self-management and the emotional dimension of quality of life. All these results highlight the importance of both personality traits and psychosocial factors in the management of T2DM. In future studies, longitudinal designs should be used to examine these relationships in terms of causality. In addition, the effects of psychosocial interventions to be applied to individuals with Type D personality traits on diabetes management and quality of life should be evaluated.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eT2DM\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eType 2 Diabetes Mellitus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eHADS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHospital Anxiety and Depression Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eDS14\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eType D Personality Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eHbA1c\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHemoglobin A1c\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eDSMQ\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDiabetes Self-Management Questionnaire\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eANOVA\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAnalysis of variance\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003ePROCESS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHayes\u0026rsquo; PROCESS Macro for SPSS\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThis study was approved by the Ethics Committee of Giresun Training and Research Hospital (Decision No: 19.03.2025/12; Approval Date: 24.03.2025). All procedures were conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e Data are available from the corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003eM.H.Ş. conceived and designed the study, collected the data, and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003eU.K. conducted the literature review, verified the data, performed statistical analyses, and contributed to the discussion.\u003c/p\u003e\n\u003cp\u003eS.A. supervised the methodological and statistical procedures, contributed to data collection, and critically revised the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e The authors would like to thank all participants and staff at the Internal Medicine Outpatient Clinics of Giresun University Education and Research Hospital for their assistance in the data collection process.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eOng KL, Stafford LK, McLaughlin SA, Boyko EJ, Vollset SE, Smith AE, et al. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023;402(10397):203\u0026ndash;34. https://doi.org/10.1016/S0140-6736(23)01301-6\u003c/li\u003e\n \u003cli\u003eSu J, Luo Y, Hu S, Tang L, Ouyang S. Advances in research on type 2 diabetes mellitus targets and therapeutic agents. Int J Mol Sci.2023;24(17):13381. https://doi.org/10.3390/ijms241713381\u003c/li\u003e\n \u003cli\u003eSendekie AK, Limenh LW, Bizuneh GK, Kasahun AE, Wondm SA, Tamene FB, et al. Psychological distress and its impact on glycemic control in patients with diabetes, Northwest Ethiopia. Front Med (Lausanne). 2025;12:1488023. \u0026nbsp;https://doi.org/10.3389/fmed.2025.1488023\u003c/li\u003e\n \u003cli\u003eJacob R, Biju B, Sharma RK. Psychologic distress in diabetic patients. J Drug Deliv Ther. 2024;14(9):1\u0026ndash;8. https://doi.org/10.22270/jddt.v14i6.6663\u003c/li\u003e\n \u003cli\u003eKinyanjui GM, Gathuci RW. Psychological factors influencing self-management challenges in type 2 diabetes among adult patients at Lamu Hospital, Kenya. J Psychol Behav Sci. 2025;4(1):1\u0026ndash;12. https://doi.org/10.51317/jpbs.v4i1.699\u003c/li\u003e\n \u003cli\u003eLodder P, Kupper N, Antens M, Wicherts JM. A systematic review comparing two popular methods to assess a Type D personality effect. Gen Hosp Psychiatry. 2021;71:62\u0026ndash;75. https://doi.org/10.1016/j.genhosppsych.2021.04.002\u003c/li\u003e\n \u003cli\u003eNefs G, Speight J, Pouwer F, Pop V, Bot M, Denollet J. Type D personality, suboptimal health behaviors and emotional distress in adults with diabetes: results from Diabetes MILES\u0026ndash;The Netherlands. 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Hemşirelik Bilimi Dergisi. 2019;1(3):1\u0026ndash;6. https://dergipark.org.tr/tr/pub/hbd/issue/43003/468294\u003c/li\u003e\n \u003cli\u003eSnaith RP. The Hospital Anxiety and Depression Scale. Health Qual Life Outcomes. 2003;1(1):29. https://doi.org/10.1186/1477-7525-1-29\u003c/li\u003e\n \u003cli\u003eAydemir O. Hastane Anksiyete ve Depresyon \u0026Ouml;l\u0026ccedil;eği T\u0026uuml;rk\u0026ccedil;e formunun ge\u0026ccedil;erlilik ve g\u0026uuml;venirliği. Turk Psikiyatri Derg. 1997;8:187\u0026ndash;280.\u003c/li\u003e\n \u003cli\u003eDenollet J. DS14: standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosom Med. 2005;67(1):89\u0026ndash;97. https://doi.org/10.1097/01.psy.0000149256.81953.49\u003c/li\u003e\n \u003cli\u003e\u0026Ouml;nc\u0026uuml; E, Vayısoğlu SK. D Tipi Kişilik \u0026Ouml;l\u0026ccedil;eğinin T\u0026uuml;rk toplumunda ge\u0026ccedil;erlilik ve g\u0026uuml;venirlik \u0026ccedil;alışması. 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Health Qual Life Outcomes. 2010;8(1):9. https://doi.org/10.1186/1477-7525-8-9\u003c/li\u003e\n \u003cli\u003eMols F, Thong MS, van de Poll-Franse LV, Roukema JA, Denollet J. Type D (distressed) personality is associated with poor quality of life and mental health among 3080 cancer survivors. J Affect Disord. 2012;136(1\u0026ndash;2):26\u0026ndash;34. https://doi.org/10.1016/j.jad.2011.08.034\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-endocrine-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bend","sideBox":"Learn more about [BMC Endocrine Disorders](http://bmcendocrdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bend/default.aspx","title":"BMC Endocrine Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Diabetes mellitus, Type 2, Type D personality, Self-management, Anxiety, Quality of life","lastPublishedDoi":"10.21203/rs.3.rs-8181318/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8181318/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThis study aims to examine the role of Type D personality in diabetes control, diabetes self-management, and quality of life in patients with Type 2 Diabetes Mellitus (T2DM). The management of this disease is critical in terms of complications and quality of life. Psychosocial factors can negatively affect diabetes management and the course of the disease. Although studies comparing patients with healthy controls exist, differences in diabetes management and regulation levels have not been sufficiently investigated.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis cross-sectional, comparative study involved 318 participants: 109 with regulated T2DM, 101 with disregulated T2DM, and 108 healthy controls. Individuals with T2DM completed the DSMQ, HADS, DS14, and SF-36 scales, while healthy controls completed all except the DSMQ. Statistical analyses included group comparisons, binary logistic regression, and mediation/moderation analyses using the SPSS PROCESS macro.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIn individuals with dysregulated T2DM, Type D personality traits were found to be more common, anxiety and depression levels were higher, and diabetes self-management and quality of life were lower. Type D personality is associated with low self-management skills and reduced quality of life. Diabetes self-management has been found to partially mediate the negative effects of Type D personality on health and to weaken the positive effects of self-management.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eType D is associated with lower quality of life and poor self-management in individuals with T2DM due to high anxiety and inadequate diabetes management. It demonstrates that Type D, affect both behavior and psychology in diabetes care. Treatment should assess psychological distress and personality and develop strategies targeting these issues to improve disease management and quality of life.\u003c/p\u003e","manuscriptTitle":"Type D Personality and Diabetes Self-Management in Type 2 Diabetes: A Mediation–Moderation Model on Glycemic Control and Quality of Life","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-02 15:04:19","doi":"10.21203/rs.3.rs-8181318/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-09T09:00:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"255210304767792522956156312262736779891","date":"2026-01-05T07:12:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-24T14:43:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"218070348788715405907625467456779981182","date":"2025-12-03T16:05:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-01T03:33:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-01T03:32:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-27T09:17:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-26T14:46:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Endocrine Disorders","date":"2025-11-26T14:34:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-endocrine-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bend","sideBox":"Learn more about [BMC Endocrine Disorders](http://bmcendocrdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bend/default.aspx","title":"BMC Endocrine Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8986ea16-5b91-4a7c-b2b0-a6951698f24d","owner":[],"postedDate":"December 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-02T15:04:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-02 15:04:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8181318","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8181318","identity":"rs-8181318","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}