Home / Conditions / Type 2 Diabetes / How Personality and Emotions Increase Diabetes Risk

How Personality and Emotions Increase Diabetes Risk

Feb 16, 2019
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Annahita Forghan, Pharm.D. Candidate 2019, LECOM College of Pharmacy

Optimism correlated with lower incidence of type 2 in postmenopausal women.

A great percentage of the American population — 9.4% —  has diabetes, which equates to 30 million people. The risk of diabetes continues to increase with age, and at 65 years of age or older. there is a 25.2% chance of incidence of the disease, especially type 2 diabetes (the most common type of diabetes). Lately, studies have demonstrated that depression is one of the risk factors for diabetes, yet, other psychological factors, such as personality traits, have not been researched enough in how they associate with risk of type 2 diabetes. “Studies have reported that type A personality (characterized by ambitiousness, hostility, competitiveness, and impatience) and type D personality (characterized by negative affectivity and social inhibition) are associated with adverse health outcomes,”  researchers have said. On the contrary, characteristics such as optimism have differing links with health.

For example, “High levels of hostility have been associated with high fasting glucose levels, insulin resistance, and prevalent diabetes,”  according to a recent study. In another study, “cynicism was associated with incident diabetes…” But it appears that expression of negative emotions, or ambivalence (uncertainty) overexpression of negative emotions, and protective personality characteristics, like optimism, have not been assessed enough in their correlations with diabetes risk.

This prospective cohort study assessed the postmenopausal characteristics optimism, ambivalence over emotional expressiveness, negative emotional expressiveness, and hostility — these four were collected at baseline with questionnaires, and then analyzed in how they may impact the risk of type 2 diabetes incidence.

There were 139,924 postmenopausal women from 50 to 79 years old who participated and were prospectively followed from the Women’s Health Initiative for an average of 14 years. They were recruited from 40 clinical centers. All participants were followed-up every 6 months in the clinical trial though 2005, and annually in the clinical trial after 2005 and in the observational study where “12,655 women who had a history of cancer (except nonmelanoma skin cancer) at baseline; 636 who joined but provided no follow-up information; and 8,593 women with prevalent self-reported diabetes at baseline” were excluded.

The follow-up ended on February 28, 2017, and incident diabetes was the primary outcome. They used Multivariable Cox proportional hazards regression models to evaluate the associations between personality traits after menopause and diabetes occurrence. And statistical analyses were performed using SAS Version 9.4 (SAS Institute, Cary, NC). The participants were assessed for diabetes during follow-up with their report of physician-diagnosed treated diabetes.

Out of the 139,924 participates, 19,240 developed diabetes, according to the follow-up. The most optimistic postmenopausal women had had 12% (hazard ratio [HR], 0.88; 95% confidence interval [CI]: 0.84-0.92) lower risk of incident diabetes compared to the least optimistic women. The women who were the most optimistic “were more likely to be younger, White (not of Hispanic origin), more educated, have higher family income, have lower history of cardiovascular diseases, have higher prior hormone use, have lower BMI, have higher levels of physical activity, have higher HEI-200 score, smoke less, consume moderate levels of alcohol, and were less likely to have depressive symptoms,” according to the study. These were confounding factors that were accounted for. HEI is a healthy eating index score that measured the quality of their diet. Women who expressed themselves the most negatively or most hostile, had 9% (HR, 1.09; 95% CI: 1.05-1.14) and 17% (HR, 1.17; 95% CI: 1.12-1.23) higher risk of diabetes, respectively. And another interesting point to note is that (postmenopausal) women who did not have obesity had a stronger correlation of hostility with risk of diabetes than that of women who had obesity.

In conclusion, lower optimism and higher negative emotional expressiveness and hostility were correlated with a greater chance for diabetes to occur in postmenopausal women regardless of major health behaviors and depressive symptoms: “All correlations between personality traits were significant, with the highest correlation between optimism and hostility (r = -0.25) and lowest between NEE and AEE (r = -0.04),” researchers concluded. So this demonstrates that optimism has a significant correlation in a lower risk of type 2 diabetes. While it is of great importance to advocate for healthier behaviors and lifestyle decisions in people for diabetes prevention, women’s personality traits should also be promoted to guide clinical or programmatic intervention strategies in preventing diabetes.

Practice Pearls:

  • Type 2 diabetes risk increases with older age, and personality traits besides depression have not been investigated thoroughly enough.
  • Optimism, ambivalence over emotional expressiveness, negative emotional expressiveness, and hostility were the 4 personality traits researched in this prospective cohort study to see whether they are associated with the primary outcome — incident diabetes. It was significantly exposed that optimism was correlated with lower risk of type 2 diabetes.
  • It is important to incorporate women’s personality traits as a tool to clinically prevent diabetes.


Garcia, Lorena; Hendryx, Michael; Jonasson, Junmei M.; Luo, Juhua; Manson, JoAnn E.; Nassir, Rami; Rapp, Stephen R.; Shadyab, Aladdin H.; Tindle, Hilary A.; Wactawski-Wende, Jean; Weitlauf, Julie C. “Personality traits and diabetes incidence among postmenopausal women.” Menopause. 21 January 2019. https://journals.lww.com/menopausejournal/Abstract/publishahead/Personality_traits_and_diabetes_incidence_among.97427.aspx. 5 February 2019.

Annahita Forghan, Pharm.D. Candidate 2019, LECOM College of Pharmacy