title: Prospective associations between emotional distress and poor outcomes in type 2 diabetes.
abstract: OBJECTIVE
  Cross-sectional studies link both depressive symptoms (DS) and diabetes-related distress (DRD) to diabetes self-management and/or glycemic control. However, longitudinal studies of these variables are rare, and their results are somewhat conflicting. The study objective was to compare DS and DRD as longitudinal predictors of medication adherence, self-care behavior, and glycemic control in type 2 diabetes.
  
  
  METHODS
  Primary care patients with type 2 diabetes reported DS, DRD, and other variables at baseline were studied. Medication adherence, self-care behaviors (diet, physical activity, and glucose testing), and glycemic control (HbA(1c)) were assessed 6 months later (n = 253). Cross-sectional and longitudinal regression analyses were used to model behavioral and medical outcomes as a function of baseline confounders, DS, and DRD.
  
  
  RESULTS
  Adjusted cross-sectional and longitudinal analyses yielded very similar results. In the latter, only DS were significantly associated with future diet behavior (P = 0.049), physical activity (P = 0.001), and glucose testing (P = 0.018). In contrast, only DRD predicted future glycemic control (P < 0.001) and medication adherence (P = 0.011).
  
  
  CONCLUSIONS
  Distress-outcome associations seem to vary by type of distress under consideration. Only DS predicts future lifestyle-oriented self-management behaviors. In contrast, only DRD predicts glycemic control, perhaps by decreasing medication adherence. Clinical assessment and intervention should encompass both types of distress, unless the goal is to narrowly target a highly specific outcome.
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA. aikensj@umich.edu
authors.forename: James E
authors.initials: JE
authors.lastname: Aikens
mesh_terms: D003430:Cross-Sectional Studies; D003863:Depression / Q000097:blood / Q000378:metabolism / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000378:metabolism / Q000473:pathology* / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence / Q000523:psychology
chemical_list: D006442:Glycated Hemoglobin