Medical College of Wisconsin
CTSICores SearchResearch InformaticsREDCap

Pathways for the relationship between diabetes distress, depression, fatalism and glycemic control in adults with type 2 diabetes. J Diabetes Complications 2017 01;31(1):169-174



Pubmed ID


Pubmed Central ID




Scopus ID

2-s2.0-84991272062   10 Citations


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 (chi(903)=24,088.91, p<0.0001, R=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.

Author List

Asuzu CC, Walker RJ, Williams JS, Egede LE


Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin
Rebekah Walker PhD Assistant Professor in the Medicine department at Medical College of Wisconsin
Joni Williams MD, MPH Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Combined Modality Therapy
Cost of Illness
Cross-Sectional Studies
Diabetes Mellitus, Type 2
Glycated Hemoglobin A
Health Knowledge, Attitudes, Practice
Middle Aged
Models, Psychological
Primary Health Care
Psychiatric Status Rating Scales
Psychosocial Support Systems
Southeastern United States
Stress, Psychological
jenkins-FCD Prod-387 b0ced2662056320369de4e5cd5f21c218c03feb3