Faculty Collaboration Database

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

Date

10/18/2016

Pubmed ID

27746088

Pubmed Central ID

PMC5209296

DOI

10.1016/j.jdiacomp.2016.09.013

Scopus ID

2-s2.0-84991272062 (requires institutional sign-in at Scopus site)   52 Citations

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.

Author List

Asuzu CC, Walker RJ, Williams JS, Egede LE

Authors

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

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

Aged
Anxiety
Combined Modality Therapy
Cost of Illness
Cross-Sectional Studies
Depression
Diabetes Mellitus, Type 2
Female
Health Knowledge, Attitudes, Practice
Humans
Hyperglycemia
Hypoglycemia
Male
Middle Aged
Models, Psychological
Primary Health Care
Psychiatric Status Rating Scales
Psychosocial Support Systems
Self-Management
Southeastern United States
Stress, Psychological