Lawrence Fisher1, Danielle Hessler2, William Polonsky3, Lisa Strycker4, Vicky Bowyer5, Umesh Masharani6. 1. Department of Family & Community Medicine, University of California, San Francisco, CA, USA. Electronic address: larry.fisher@ucsf.edu. 2. Department of Family & Community Medicine, University of California, San Francisco, CA, USA. Electronic address: danielle.hessler@ucsf.edu. 3. Behavioral Diabetes Institute, Department of Psychiatry, University of California, San Diego, CA, USA. Electronic address: whp@behavioraldiabetes.org. 4. Oregon Research Institute, Eugene, OR, USA. Electronic address: lisas@ori.org. 5. Department of Family & Community Medicine, University of California, San Francisco, CA, USA. Electronic address: vicky.bowyer@ucsf.edu. 6. Department of Medicine, University of California, San Francisco, CA, USA. Electronic address: umesh.masharani@ucsf.edu.
Abstract
OBJECTIVE: We tested three models to determine how improvements in emotion regulation (ER) and cognitive skills (CS) as a result of intervention operate to affect reductions in diabetes distress DD. METHODS: Change data were drawn from the baseline and 9-month T1-REDEEM trial. Adults with type 1 diabetes were recruited from several U.S. states and Toronto, Canada. A primary and two alternative structural equation models were tested to explore the directionality of effect: primary model - changes in ER and CS drive changes in DD; reverse model - changes in DD drive changes in ER and CS; and bidirectional model - changes in ER, CS and DD occur together with no directionality. RESULTS: All three models displayed a good fit to the data. The primary model indicated 7 significant directional pathways: improvements in ER and CS operate together to drive reductions in DD. The reverse model only indicated that reductions in DD affected changes in one CS variable; and the bidirectional model indicated only that these results were bidirectional. Reductions in all tested domains of DD occurred together. CONCLUSIONS: Improvements in ER and CS drive reductions in DD. PRACTICE IMPLICATIONS: Interventions to reduce high DD should focus on improving ER and CS.
OBJECTIVE: We tested three models to determine how improvements in emotion regulation (ER) and cognitive skills (CS) as a result of intervention operate to affect reductions in diabetes distress DD. METHODS: Change data were drawn from the baseline and 9-month T1-REDEEM trial. Adults with type 1 diabetes were recruited from several U.S. states and Toronto, Canada. A primary and two alternative structural equation models were tested to explore the directionality of effect: primary model - changes in ER and CS drive changes in DD; reverse model - changes in DD drive changes in ER and CS; and bidirectional model - changes in ER, CS and DD occur together with no directionality. RESULTS: All three models displayed a good fit to the data. The primary model indicated 7 significant directional pathways: improvements in ER and CS operate together to drive reductions in DD. The reverse model only indicated that reductions in DD affected changes in one CS variable; and the bidirectional model indicated only that these results were bidirectional. Reductions in all tested domains of DD occurred together. CONCLUSIONS: Improvements in ER and CS drive reductions in DD. PRACTICE IMPLICATIONS: Interventions to reduce high DD should focus on improving ER and CS.
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