Psychological Resilience and Psychosocial Adaptation in Type 2 Diabetes Mellitus: Associations with Executive Functioning and Clinical Indicators

BACKGROUND:Type 2 diabetes mellitus (T2DM) has been associated with executive-function vulnerability, yet the role of psychological resilience in neuropsychological and psychosocial functioning remains unclear. This study examined whether resilience was associated with executive-function performance, clinical indicators, and psychosocial adaptation in adults with T2DM and healthy controls. METHODS:This cross-sectional study included 206 adults (102 with T2DM and 104 healthy controls) after excluding individuals with low global cognitive screening scores. Resilience was assessed using the Connor-Davidson Resilience Scale and classified as low or moderate-to-high. Participants completed executive-function tests and questionnaires assessing diabetes self-management, depressive symptoms, quality of life, and perceived family support. General linear models controlled for age and education, with Holm-Bonferroni correction applied within related outcome sets; sensitivity analyses additionally adjusted for depressive symptoms and body mass index. RESULTS:Participants with T2DM showed poorer Digit Span and WCST performance after correction, indicating vulnerabilities in attention span, working memory, cognitive flexibility, and concept formation. A significant disease status × resilience interaction was found for Tower of London (planning) performance; simple main-effects analysis indicated a significant resilience effect within the T2DM group but not among controls, and this interaction remained significant after adjustment for depressive symptoms and body mass index. Resilience was broadly associated with better psychosocial outcomes, and lower resilience in T2DM was also associated with higher mean HbA1c and systolic blood pressure. DISCUSSION:T2DM was associated with executive-function vulnerability, whereas resilience was selectively related to planning performance and more broadly associated with psychosocial adaptation.