title: Hemoglobin A1c improvements and better diabetes-specific quality of life among participants completing diabetes self-management programs: a nested cohort study.
abstract: BACKGROUND
  Numerous primary care innovations emphasize patient-centered processes of care. Within the context of these innovations, greater understanding is needed of the relationship between improvements in clinical endpoints and patient-centered outcomes. To address this gap, we evaluated the association between glycosylated hemoglobin (HbA1c) and diabetes-specific quality of life among patients completing diabetes self-management programs.
  
  
  METHODS
  We conducted a retrospective cohort study nested within a randomized comparative effectiveness trial of diabetes self-management interventions in 75 diabetic patients. Multiple linear regression models were developed to examine the relationship between change in HbA1c from baseline to one-year follow-up and Diabetes-39 (a diabetes-specific quality of life measure) at one year.
  
  
  RESULTS
  HbA1c levels improved for the overall cohort from baseline to one-year follow-up (t (74) = 3.09, p = .0029). One-year follow up HbA1c was correlated with worse overall quality of life (r = 0.33, p = 0.004). Improvements in HbA1c from baseline to one-year follow-up were associated with greater D-39 diabetes control (β = 0.23, p = .04) and D-39 sexual functioning (β = 0.25, p = .03) quality of life subscales.
  
  
  CONCLUSIONS
  Improvements in HbA1c among participants completing a diabetes self-management program were associated with better diabetes-specific quality of life. Innovations in primary care that engage patients in self-management and improve clinical biomarkers, such as HbA1c, may also be associated with better quality of life, a key outcome from the patient perspective.
authors.affiliation: Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Khanna
authors.forename: Amber L
authors.initials: AL
authors.lastname: Bush
authors.forename: J Michael
authors.initials: JM
authors.lastname: Swint
authors.forename: Melissa Fleschler
authors.initials: MF
authors.lastname: Peskin
authors.forename: Richard L
authors.initials: RL
authors.lastname: Street
authors.forename: Aanand D
authors.initials: AD
authors.lastname: Naik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015190:Blood Glucose Self-Monitoring / Q000191:economics; D015992:Body Mass Index; D015331:Cohort Studies; D057186:Comparative Effectiveness Research; D017281:Cost of Illness; D003669:Deductibles and Coinsurance / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006787:Hospitals, Veterans; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D010865:Pilot Projects; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D012648:Self Care / Q000191:economics*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013781:Texas; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents