The stress-buffering model of social support in glycaemic control in adolescents with type 1...

Social Bonding

Social bonding refers to the neurobiology of socialattachment and relies on the neural systemsinvolved in reproduction, social engagementbehaviours, and homeostasis. Centrally activeneuropeptides, such oxytocin and vasopressin, playa role in bond formation (Carter & Porges, 2010).

Researchers agree that social bonding has long-termconsequences for psychological, behavioural andphysiological well-being (Karelina & DeVries, 2010).

The processes through which social interactioninfluences disease pathogenesis and progression stillremain largely unidentified in human research.

Animal research indicates three endogenousmechanisms (Karelina & DeVries, 2010):

Theoretical Background

Stress-Buffering Hypothesis(Cohen & Wills, 1985)

Down-regulation of the hypothalamic-adrenal-pituitary (HPA) axis by social bonding is a convincingmechanism for the benefits of social support(Hostinar, Sullivan, & Gunnar, 2014).

Evidence suggests that oxytocin (OT) attenuatesstress, fear and anxiety via two pathways:

Oxytocin and Type 1 Diabetes

Cortisol increases the transport of energy to musclesvia heightened gluconeogenesis and decreasedglycogenolysis (Khani & Tayek, 2001). Both increasecirculating blood glucose, which will contributetowards hyperglycaemia. AWT1D with chronicallyincreased stress are therefore at greater risk of poormetabolic control and, in the long-run, diabeticcomplications (Giacco & Brownlee, 2010).

If OT is able to down-regulate this response via itsaction on the HPA axis, it may aid metabolic controland provide a biological explanation for the impactof social support in AWT1D:

Oxytocin

Glucocorticoids

Inflammatory signals

Aim

To investigate a potential biological mechanism through which social support is related to diabetes

outcomes

Objective

Assess if the stress-buffering hypothesis

is applicable to AWT1D via the

measurement of oxytocin and cortisol

Hypothesis 1

Greater salivary OT will be associated

with reduced salivary cortisol and improved

glycaemic control (HbA1c)

Hypothesis 2

Gender differences will exist in the

relationship between social support and diabetes outcomes (self-care & HbA1c)

Participants

• n=60

• 29 males, 31 females

• M age = 16.59 (SD=.96)

• 54 MDI, 5 CSII pump

• M HbA1c = 11.3mmol/L

Design

• Cross-sectional

• Two general hospitals in East Midlands

• Paediatric Outpatients

Materials

• Self-Care Inventory –Revised (Weinger et al., 2005)

Bio

Markers

• Salivary OT

• Salivary Cortisol

• Collected via Salivette ®

• HbA1c

Procedure

• During routine clinic visit

• Participants provided 2 saliva samples

• Completed questionnaires

Aims & Objectives

Social Support and Type 1

Diabetes

Diabetes management does not occur in isolation; alarge part of it takes place in a social world (Wysocki &Greco, 2006). Social support can have a significantimpact on diabetes outcomes in adolescents with type 1diabetes (AWT1D) (Helgeson, Siminerio, Escobar, &Becker, 2009).

Qualitative evidence suggests that AWT1D believe peersimpact their disease management (Palladino &Helgeson, 2012). However, the mechanism throughwhich this occurs is uncertain (Lehmkuhl, 2009).

This is likely to be individualised, with demographiccharacteristics playing a role, including gender.Helgeson, Lopez and Kamarck (2009) suggest conflict ismore influential in diabetes outcomes than supportamong female adolescents. Males report lower levels ofpeer support overall (Helgeson et al., 2007), potentiallydue to illness non-disclosure (Greco et al., 2003).

Results

Hypothesis 1• OT related to cortisol (r(54)=-.35, p=.011, 95% CI [-.52, -

.14]) but not HbA1c (r(54)=.13, p=.368, 95% CI [-.09, .32])

Hypothesis 2• OT was not associated with self-care (Females:

r(24)=.18, p=.372, 95% CI[-.22, .53], Males: r(25)=.00,

p=.998, 95% CI [.96, .99]) or HbA1c (Females: r(24)=.23,p=.270, 95% CI[-.18, .56], Males: r(25)=.07, p=.740, 95% CI [-

.31, .42]) for either gender.

• A positive relationship was indicated betweencortisol and self-care in males (r(25)=.44, p=.021, 95%

CI [.18, .68]) but not females (r(24)=.01, p=.981, 95% CI [-.39, .38]).

• This relationship was maintained during regressionanalysis (β=-.437, t(28)=-2.53, p=.018 95% CI [-.008, .004]).

• Cortisol explains a significant proportion of thevariance in self-care in males (r2=.19, F(1,27)=6.38,p=.018).

• OT was not related to HbA1c for either gender(Females: r(24)=-.05, p=.799 95% CI[-.43, .34], Males:

r(25)=.-05, p=.802, 95% CI [-.41, .32]).

Discussion

• OT is not related to diabetes outcomes. Therefore,the mechanism through which social support isassociated with glycaemic control is not via the HPAaxis.

• Paradoxically, a positive impact of cortisol on self-carebehaviours was found. It is suggested that a sufficientamount of stress is required to increase self-carebehaviours.

• It is proposed that optimal stress provides motivationto appropriately self-manage in males.

• Further research is required to assess if this stress isdisease-specific, or if daily hassles and other genericsources are also associated with this improved self-management.

References• Carter, C. S., & Porges, S. W. (2010). Social bonding and attachment. In G. F. Koob, M. Le Moal, & R. F. Thompson (Eds.), Encyclopedia of Behavioral Neuroscience (pp. 257–262). Oxford:

Academic Press.• Cohen, S., & Wills, T. A. (1985). Stress, social support and the buffering hypothesis. Psychological Bulletin, 98(2), 310.• Giacco, F., & Brownlee, M. (2010). Oxidative stress and diabetic complications. Circulation Research, 107(9), 1058–1070.• Greco, P., Harris, M., Milkes, A., Sadler, M., Mertlich, D., & Jones, J. (2003). Revealing the diagnosis of diabetes to friends: The beginnings of social support. Diabetes, 52, A414.• Helgeson, V. S., Lopez, L. C., & Kamarck, T. (2009). Peer Relationships and Diabetes : Retrospective and Ecological Momentary Assessment Approaches. Health Psychology, 28(3), 273–282. • Helgeson, V. S., Siminerio, L., Escobar, O., & Becker, D. (2009). Predictors of metabolic control among adolescents with diabetes: A 4-year longitudinal study. Journal of Pediatric

Psychology, 34(3), 254–270.• Hostinar, C. E., Sullivan, R. M., & Gunnar, M. R. (2014). Psychobiological mechanisms underlying the social buffering of the hypothalamic-pituitary-adrenocortical axis: a review of animal

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Method

Modulation of the HPA

axis (Neumann,

2002)

Facilitation of pro-social behaviours

(Carter, 2007)

Reduced stress