Relationship between sense of coherence and diabetes mellitus: a systematic review

Márquez-Palacios, Jesús Humberto; Yanez-Peñúñuri, Libia Yanelli; Salazar-Estrada, José Guadalupe

doi:10.1590/1413-812320202510.34312018

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REVIEW • Ciênc. saúde coletiva 25 (10) • Oct 2020 • https://doi.org/10.1590/1413-812320202510.34312018 copy

Relationship between sense of coherence and diabetes mellitus: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The aim was to synthesize the best scientific evidence on the effect of sense of coherence in disease development, treatment, and biomedical metabolic control indicators, as well as the complications involved for people at risk of developing diabetes and for diabetics. The systematic review method was implemented. Search and selection efforts of two independent reviewers on Scopus, Web of Science, PubMed, Ebsco, Science Direct, and manuals databases, available until 2017, in Spanish and English, of the population aged 18 and over. From a total of 154 studies, 20 articles were included in the systematic review. Over half of the studies used the SOC-13 version to verify the sense of coherence and the most frequent indicator of metabolic control was glycated hemoglobin. In addition to this, 14 of the 20 studies found a statistically significant relationship between sense of coherence and diabetes. It is concluded that the sense of coherence has a strong correlation with diabetes in the different phases of the disease and is related to the reduction of risk for the development of the disease, a reduction of glycated hemoglobin values, and the appearance of diabetes mellitus-related complications.

Key words
Chronic disease; Diabetes mellitus; Salutogenesis; Health promotion; Life style

Author and year	Type of study	Instrument	Indicators	DM Type	Population and age average in years
Lundman and Norberg, 1993²⁶26 Lundman B, Norberg A. The significance of a sense of coherence for subjective health in persons with insulin-dependent diabetes. J Adv Nurs 1993; 18(3):381-386.	CS	SOC-29	A1c	DM1	N = 20, M = N/A, W = N/A Age: N/A
Sandén-Eriksson, 2000⁴²42 Sandén-Eriksson B. Coping with type-2 diabetes: the role of sense of coherence compared with active management. J Adv Nurs 2000; 31(6):1393-1397.	L	SOC-13	A1c	DM2	N = 88, M = 57%, W = 43% Age: x̅ = 65 σ = 10 M, x̅ = 69 σ = 10 W
Richardson et al., 2001²⁷27 Richardson A, Adner N, Nordström G. Persons with insulin-dependent diabetes mellitus: acceptance and coping ability. J Adv Nurs 2001; 33(6):758-763.	CS	SOC-29	A1c, CO^* * Obtained from medical file.	DM1	N = 107, M = 44%, W = 56% Age: x̅ = 43 σ = 12
Shiu, 2004⁴⁴44 Shiu ATY. Sense of coherence amongst Hong Kong Chinese adults with insulin-treated type 2 diabetes. Int J Nurs Stud 2004; 41(4):387-396.	CS	SOC-13	A1c	DM2	N = 72, M = 39%, W = 61%; with Tx of insulin Age: x̅ = 52 σ = 12
Agardh et al., 2003³⁵35 Agardh EE, Ahlbom A, Andersson T, Efendic S, Grill V, Hallqvist J, Norman A, Ostenson CG. Work stress and low sense of coherence is associated with type 2 diabetes in middle-aged Swedish women. Diabetes Care 2003; 26(3):719-724.	CC	SOC-3	PTOG, HOMA	DM2	N = 4821, M = 0%, W = 100%; with and without DM Age: N/A
Agardh et al., 2004³⁹39 Agardh EE, Ahlbom A, Andersson T, Efendic S, Grill V, Hallqvist J, Ostenson CG. Explanations of socioeconomic differences in excess risk of type 2 diabetes in Swedish men and women. Diabetes Care 2004; 27(3):716-721.	CS	SOC-3	PTOG, IMC	DM2	N = 7950, M = 39%, W = 61%; with and without DM2 Age: N/A
Cohen and Kanter, 2004⁴³43 Cohen M, Kanter Y. Relation between sense of coherence and glycemic control in type 1 and type 2 diabetes. Behav Med Wash DC 2004; 29(4):175-183.	CC	SOC-29	A1c	DM1 and DM2	N = 96, M = 61%, W = 39%; with and without DM Age: x̅ = 51 σ = 15 DM1, x̅ = 55 σ = 11 DM2, x̅ = 51 σ = 13 without DM
Hilding et al., 2006³⁶36 Hilding A, Eriksson AK, Agardh EE, Grill V, Ahlbom A, Efendic S, Ostenson CG. The impact of family history of diabetes and lifestyle factors on abnormal glucose regulation in middle-aged Swedish men and women. Diabetologia 2006; 49(11):2589-2598.	CS	SOC-3	PTOG	PD and DM2	N = 7949, M = 39%, W = 61% Age: x̅ = 47 σ = 5 M with and without FHD, x̅ = 47 σ = 5 W with and without FHD
Kouvonen et al., 2008²⁰20 Kouvonen AM, Väänänen A, Woods SA, Heponiemi T, Koskinen A, Toppinen-Tanner S. Sense of coherence and diabetes: A prospective occupational cohort study. BMC Public Health 2008; 8:46.	C	SOC-13	N/D	DM2	N = 5827, M = 100%, W = 0%; with and without CD. Age: x̅ = 39 σ = 10
Abdelgadir et al., 2009⁴⁵45 Abdelgadir M, Shebeika W, Eltom M, Berne C, Wikblad K. Health related quality of life and sense of coherence in Sudanese diabetic subjects with lower limb amputation. Tohoku J Exp Med 2009; 217(1):45-50.	CS	SOC-13	N/D	DM	N = 120, M = 52%, W = 48%; with and without LLA Age: x̅ = 57 σ = 10, M and W with LLA, x̅ = 53 σ = 11, M and W without LLA
Ahola et al., 2010²¹21 Ahola AJ, Saraheimo M, Forsblom C, Hietala K, Groop PH, FinnDiane Study Group. The cross-sectional associations between sense of coherence and diabetic microvascular complications, glycaemic control, and patients' conceptions of type 1 diabetes. Health Qual Life Out-comes 2010; 8:142.	CS	SOC-13	A1c, IMC, IEA, ERET and PRP^* * Obtained from medical file.	DM1	N = 1264, M= 45%, W = 55% Age: x̅ = 44 σ = 12 GSS, x̅ = 45 σ = 12 GSW
Ahola et al., 2012²⁴24 Ahola AJ, Mikkilä V, Saraheimo M, Wadén J, Mäkimattila S, Forsblom C, Freese R, Groop PH, FinnDiane Study Group. Sense of coherence, food selection and leisure time physical activity in type 1 diabetes. Scand J Public Health 2012; 40(7):621-628.	CS	SOC-13	IMC, PSD, PSS, A1c, c-HDL and NT	DM1	N = 1104, M = 44%, W = 56% Age: x̅ = 45 σ = 12
Peer et al., 2012³⁷37 Peer N, Steyn K, Lombard C, Lambert EV, Vythilingum B, Levitt NS. Rising diabetes prevalence among urban-dwelling black South Africans. PloS One 2012; 7(9):e43336.	CS	SOC-13	PTOG	DM	N = 1071, M = 47.5%, W = 52.5%; with and without DM Age: x̅ = 43 σ = 13
Merakou et al., 2013³⁸38 Merakou K, Koutsouri A, Antoniadou E, Barbouni A, Bertsias A, Karageorgos G, Lionis C. Sense of coherence in people with and without type 2 diabetes mellitus: an observational study from Greece. Ment Health Fam Med 2013; 10(1):3-13.	CC	SOC-29	N/D	DM2	N = 202, M = 51%, W = 49%; with and without DM2 Age: x̅ = 67 σ = N/A group with DM2, x̅ = 71 σ = N/A group without DM2
Eriksson et al, 2013⁴⁰40 Eriksson AK, van den Donk M, Hilding A, Östenson CG. Work stress, sense of coherence, and risk of type 2 diabetes in a prospective study of middle-aged Swedish men and women. Diabetes Care 2013; 36(9):2683-2689.	C	SOC-3	PTOG	PD and DM2	N = 4985, M = 41%, W = 59 with and without NGT Age: W x̅ = 47 σ = 5 NGT, x̅ = 50 σ = 4 PD, x̅ = 49 σ = 4 DM2; M x̅ = 46 σ = 5 NGT, x̅ = 47 σ = 5 PD, x̅ = 47 σ = 5 DM2.
Thomsen et al., 2014⁴⁶46 Thomsen NOB, Björk J, Cederlund RI. Health-related quality of life 5 years after carpal tunnel release among patients with diabetes: a prospective study with matched controls. BMC Endocr Disord 2014; 14:85.	L	SOC-13	A1c	DM1 and DM2	N = 66, M = 38%, W = 62%; with and without DM Age: N/D
Nilsen et al., 2015²⁵25 Nilsen V, Bakke PS, Rohde G, Gallefoss F. Is sense of coherence a predictor of lifestyle changes in subjects at risk for type 2 diabetes? Public Health 2015; 129(2):155-161.	RCT	SOC-13	Protocolo de Bruce	DM2	N = 213, M = 50% W = 50%; at DM2 Age: x̅ = 46 σ = 11
Linden et al., 2016⁴¹41 Linden K, Sparud-Lundin C, Adolfsson A, Berg M. Well-Being and Diabetes Management in Early Pregnant Women with Type 1 Diabetes Mellitus. Int J Environ Res Public Health 2016; 13(8):836.	CS	SOC-13	A1c	DM1	N = 168, M = 0%, W = 100%; pregnant with DM1 Age: x̅ = 31 σ = 5
Olesen et al., 2017²³23 Olesen K, Jensen TM, Diaz LJ, Møller ACL, Willaing I, Lyssenko V. Sense of Coherence is associated with LDL-cholesterol in patients with type 1 diabetes - The PROLONG-Steno study. J Clin Transl Endocrinol 2017; 8:1-5.	CS	SOC-13	A1c, PSD, PSS, c-LDL c-HDL and NT	DM1	N = 125, M= 42%, W = 58% Age: x̅ = 61 σ = 10
Nuccitelli et al., 2017²²22 Nuccitelli C, Valentini A, Caletti MT, Caselli C, Mazzella N, Forlani G, Marchesini G. Sense of coherence, self-esteem, and health locus of control in subjects with type 1 diabetes mellitus with/without satisfactory metabolic control. J Endocrinol Invest 2017; 41(3):307-314.	CS	SOC-29	A1c, IMC and c-LDL	DM1	N = 97, M = 45%, W = 55% with and without MC Age: x̅ = 41 σ = 10 with MC, x̅ = 41 σ = 11 without MC

Author and year	Category	Controlled variables	Main results
Agardh et al., 2003³⁵35 Agardh EE, Ahlbom A, Andersson T, Efendic S, Grill V, Hallqvist J, Norman A, Ostenson CG. Work stress and low sense of coherence is associated with type 2 diabetes in middle-aged Swedish women. Diabetes Care 2003; 26(3):719-724.	RDDM	BMI, WHR, PA, smoking and FHD.	Weak SOC associated with RDDM and risk of insulin resistance.
Agardh et al., 2004³⁹39 Agardh EE, Ahlbom A, Andersson T, Efendic S, Grill V, Hallqvist J, Ostenson CG. Explanations of socioeconomic differences in excess risk of type 2 diabetes in Swedish men and women. Diabetes Care 2004; 27(3):716-721.	RDDM	N/A	The SOC modified the relative risk of developing DM2
Hilding et al., 2006³⁶36 Hilding A, Eriksson AK, Agardh EE, Grill V, Ahlbom A, Efendic S, Ostenson CG. The impact of family history of diabetes and lifestyle factors on abnormal glucose regulation in middle-aged Swedish men and women. Diabetologia 2006; 49(11):2589-2598.	RDDM	BMI, PA and smoking.	Weak SOC increased the risk of DM2
Kouvonen et al., 2008²⁰20 Kouvonen AM, Väänänen A, Woods SA, Heponiemi T, Koskinen A, Toppinen-Tanner S. Sense of coherence and diabetes: A prospective occupational cohort study. BMC Public Health 2008; 8:46.	RDDM	Socio-demographic variables, PS, HSA, smoking, alcohol consumption and PA.	People over the age of 50 with weak SOC are more at RDDM at a rate of up to 46%
Peer et al., 2012³⁷37 Peer N, Steyn K, Lombard C, Lambert EV, Vythilingum B, Levitt NS. Rising diabetes prevalence among urban-dwelling black South Africans. PloS One 2012; 7(9):e43336.	RDDM	PI, fat intake, BMI, WHR, FHD, age, sex and urbanization	Weak SOC was significantly associated to a greater RDDM.
Eriksson et al., 2013⁴⁰40 Eriksson AK, van den Donk M, Hilding A, Östenson CG. Work stress, sense of coherence, and risk of type 2 diabetes in a prospective study of middle-aged Swedish men and women. Diabetes Care 2013; 36(9):2683-2689.	RDDM	FHD, BMI, smoking, PA, schooling and PS	No association between weak SOC and DM2 in M or W.

Author and year	Category	Controlled variables	Main results
Nilsen et al., 2015²⁵25 Nilsen V, Bakke PS, Rohde G, Gallefoss F. Is sense of coherence a predictor of lifestyle changes in subjects at risk for type 2 diabetes? Public Health 2015; 129(2):155-161.	TTO	N/A	Patients with strong SOC are 14 times more likely to change their LS
Ahola et al., 2012²⁴24 Ahola AJ, Mikkilä V, Saraheimo M, Wadén J, Mäkimattila S, Forsblom C, Freese R, Groop PH, FinnDiane Study Group. Sense of coherence, food selection and leisure time physical activity in type 1 diabetes. Scand J Public Health 2012; 40(7):621-628.	TTO and DC	Age, socioeconomic status, AER and ESKD	Patients with strong SOC have a lower triglyceride concentration and A1c. Strong SOC is associated with good dietary choices, in W and greater PA in M.
Lundman and Norberg, 1993²⁶26 Lundman B, Norberg A. The significance of a sense of coherence for subjective health in persons with insulin-dependent diabetes. J Adv Nurs 1993; 18(3):381-386.	DC	N/A	No significant correlation between the SOC and A1c measurements.
Sandén-Eriksson, 2000⁴²42 Sandén-Eriksson B. Coping with type-2 diabetes: the role of sense of coherence compared with active management. J Adv Nurs 2000; 31(6):1393-1397.	DC	N/A	SOC is indirectly related to A1c through HAS
Shiu, 2004⁴⁴44 Shiu ATY. Sense of coherence amongst Hong Kong Chinese adults with insulin-treated type 2 diabetes. Int J Nurs Stud 2004; 41(4):387-396.	DC	N/A	Positive and significant correlation between SOC and A1c.
Cohen and Kanter, 2004⁴³43 Cohen M, Kanter Y. Relation between sense of coherence and glycemic control in type 1 and type 2 diabetes. Behav Med Wash DC 2004; 29(4):175-183.	DC	Socio-demographic variables, duration of DM, complications and BMI.	SOC is indirectly related to A1c through the adherence to SC conducts and psychopathological symptoms.
Linden et al., 2016⁴¹41 Linden K, Sparud-Lundin C, Adolfsson A, Berg M. Well-Being and Diabetes Management in Early Pregnant Women with Type 1 Diabetes Mellitus. Int J Environ Res Public Health 2016; 13(8):836.	DC	N/A	SOC was associated with GC. W with GC scored higher on the scale of understandability in SOC.
Olesen et al., 2017²³23 Olesen K, Jensen TM, Diaz LJ, Møller ACL, Willaing I, Lyssenko V. Sense of Coherence is associated with LDL-cholesterol in patients with type 1 diabetes - The PROLONG-Steno study. J Clin Transl Endocrinol 2017; 8:1-5.	DC	Sex, age and duration of diabetes	Negative non-linear association between strong SOC and C-LDL.
Nuccitelli et al., 2017²²22 Nuccitelli C, Valentini A, Caletti MT, Caselli C, Mazzella N, Forlani G, Marchesini G. Sense of coherence, self-esteem, and health locus of control in subjects with type 1 diabetes mellitus with/without satisfactory metabolic control. J Endocrinol Invest 2017; 41(3):307-314.	DC	Does not describe the variables used	SOC associated negatively with BMI and A1c.
Richardson et al., 2001²⁷27 Richardson A, Adner N, Nordström G. Persons with insulin-dependent diabetes mellitus: acceptance and coping ability. J Adv Nurs 2001; 33(6):758-763.	DC and DRC	N/A	No significant correlation between SOC and A1c. Strong SOC reported in people without complications or one complication.
Ahola et al., 2010²¹21 Ahola AJ, Saraheimo M, Forsblom C, Hietala K, Groop PH, FinnDiane Study Group. The cross-sectional associations between sense of coherence and diabetic microvascular complications, glycaemic control, and patients' conceptions of type 1 diabetes. Health Qual Life Out-comes 2010; 8:142.	DC and DRC	N/A	Weak SOC is associated with the worst result of A1c. Patients with strong SOC reached an A1c level below 7,5% more frequently. In M, weak SOC was associated with nephropathy. No differences in SOC measurements in retinopathy.
Abdelgadir et al., 2009⁴⁵45 Abdelgadir M, Shebeika W, Eltom M, Berne C, Wikblad K. Health related quality of life and sense of coherence in Sudanese diabetic subjects with lower limb amputation. Tohoku J Exp Med 2009; 217(1):45-50.	DRC	N/A	SOC had a negative correlation in diabetic patients with amputations.
Thomsen et al., 2014⁴⁶46 Thomsen NOB, Björk J, Cederlund RI. Health-related quality of life 5 years after carpal tunnel release among patients with diabetes: a prospective study with matched controls. BMC Endocr Disord 2014; 14:85.	DRC	N/A	No evidence of any differences in SOC among the groups of patients.

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[1] Collaborations

JH Márquez-Palacios participated in the conception, design, search and selection of articles, the quality and risk-of-bias assessment, as well as in the writing and reviewing the final version of this article. LY Yanez-Peñúñuri participated in the search and selection of articles, the quality and risk-of-bias assessment, and in the writing and reviewing the final version of this article. JG Salazar-Estrada participated in the conception, critical review, and final review of this article.