Christopher C Asuzu1, Rebekah J Walker2, Joni Strom Williams2, Leonard E Egede3. 1. College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC, USA. 2. Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA; Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA. 3. Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA; Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA. Electronic address: egedel@musc.edu.
Abstract
BACKGROUND: The aim of this study was to examine the mechanism by which depressive symptoms, diabetes distress, and diabetes fatalism together influence diabetes outcomes using structured equation modeling. METHODS: 615 adults with type 2 diabetes were recruited from two primary care clinics in the southeastern United States. Psychosocial factors found to be associated with diabetes outcomes were measured using validated questionnaires. Structured equation modeling (SEM) was used to investigate the relationship between diabetes fatalism, depressive symptoms, diabetes distress, self-care and glycemic control. RESULTS: The final model (chi2(903)=24,088.91, p<0.0001, R2=0.93, RMSEA=0.05 and CFI=0.90) showed that higher diabetes distress was directly significantly related to a decreased self-care (r=-0.69, p<0.001) and increased HbA1c (r=0.69, p<0.001). There was no significant direct association between depressive symptoms or fatalism, and glycemic control or self-care. There was, however, an indirect association between increased depressive symptoms and increased fatalism, explained through the direct association with diabetes distress in that higher depressive symptoms (0.76, p<0.001) and higher fatalism (0.11, p<0.001) were significantly associated with higher diabetes distress. CONCLUSION: Diabetes distress serves as a pathway through which depressive symptoms and fatalism impact both glycemic control and self-care. In addition, pathways between diabetes distress and both self-care behaviors and glycemic control in patients with type 2 diabetes remained separate, suggesting the need to address both psychological and behavioral factors in standard diabetes care, rather than focusing on psychological care primarily through support for self-management and treatment of depression.
BACKGROUND: The aim of this study was to examine the mechanism by which depressive symptoms, diabetes distress, and diabetes fatalism together influence diabetes outcomes using structured equation modeling. METHODS: 615 adults with type 2 diabetes were recruited from two primary care clinics in the southeastern United States. Psychosocial factors found to be associated with diabetes outcomes were measured using validated questionnaires. Structured equation modeling (SEM) was used to investigate the relationship between diabetes fatalism, depressive symptoms, diabetes distress, self-care and glycemic control. RESULTS: The final model (chi2(903)=24,088.91, p<0.0001, R2=0.93, RMSEA=0.05 and CFI=0.90) showed that higher diabetes distress was directly significantly related to a decreased self-care (r=-0.69, p<0.001) and increased HbA1c (r=0.69, p<0.001). There was no significant direct association between depressive symptoms or fatalism, and glycemic control or self-care. There was, however, an indirect association between increased depressive symptoms and increased fatalism, explained through the direct association with diabetes distress in that higher depressive symptoms (0.76, p<0.001) and higher fatalism (0.11, p<0.001) were significantly associated with higher diabetes distress. CONCLUSION:Diabetes distress serves as a pathway through which depressive symptoms and fatalism impact both glycemic control and self-care. In addition, pathways between diabetes distress and both self-care behaviors and glycemic control in patients with type 2 diabetes remained separate, suggesting the need to address both psychological and behavioral factors in standard diabetes care, rather than focusing on psychological care primarily through support for self-management and treatment of depression.
Authors: William H Polonsky; Lawrence Fisher; Jay Earles; R James Dudl; Joel Lees; Joseph Mullan; Richard A Jackson Journal: Diabetes Care Date: 2005-03 Impact factor: 19.112
Authors: Rebekah J Walker; Brittany L Smalls; Melba A Hernandez-Tejada; Jennifer A Campbell; Kimberly S Davis; Leonard E Egede Journal: Gen Hosp Psychiatry Date: 2012-08-13 Impact factor: 3.238
Authors: Rebekah J Walker; Brittany L Smalls; Jennifer A Campbell; Joni L Strom Williams; Leonard E Egede Journal: Endocrine Date: 2014-02-15 Impact factor: 3.633
Authors: Lawrence Fisher; Danielle Hessler; Russell E Glasgow; Patricia A Arean; Umesh Masharani; Diana Naranjo; Lisa A Strycker Journal: Diabetes Care Date: 2013-06-04 Impact factor: 19.112
Authors: Caroline A Presley; Favel L Mondesir; Lucia D Juarez; April A Agne; Kevin R Riggs; Yufeng Li; Maria Pisu; Emily B Levitan; Janet M Bronstein; Andrea L Cherrington Journal: Diabet Med Date: 2021-01-07 Impact factor: 4.359