Affective symptoms and change in diabetes self-efficacy and glycaemic control.
OBJECTIVE
To examine the role of baseline depression, anxiety and stress symptoms on post-intervention diabetes self-efficacy and glycaemic control (HbA(1c)).


METHODS
The current study analysed data from patients (n = 85) with treated but uncontrolled Type 2 diabetes who participated in a comparative effectiveness study of two diabetes self-management interventions. Hierarchical linear regression was used to examine the relationships between baseline affective symptoms and post-intervention diabetes self-efficacy and the moderating effects of baseline affective symptoms on the relationship between changes in diabetes self-efficacy and post-intervention HbA(1c).


RESULTS
Baseline depression was inversely associated with post-intervention diabetes self-efficacy (P = 0.0001) after adjusting for baseline characteristics including diabetes self-efficacy. In contrast, normal-mild levels of stress were associated with higher post-intervention diabetes self-efficacy (P = 0.04). Anxiety and stress symptoms significantly and independently moderated the relationship between changes in diabetes self-efficacy and post-intervention HbA(1c) (P = 0.02 and P = 0.03, respectively). Further evaluation of these interactions demonstrated that changes in diabetes self-efficacy were associated with lower post-intervention HbA(1c), but only among those with higher baseline affective symptoms.


CONCLUSIONS
We found a moderating effect across affective symptoms on the relationship between diabetes self-efficacy changes and post-intervention HbA1c in the context of a self-management intervention. Results suggest that patients with poorly controlled diabetes who have higher levels of depression, anxiety and stress symptoms may derive greater benefits from self-management interventions known to improve diabetes self-efficacy.
Houston Health Services Research and Development Center of Excellence, Michael E DeBakey Veterans Affairs Medical Center, University of Houston, Houston, TX, USA. smr1@bcm.tmc.edu
S M
SM
Robertson
A B
AB
Amspoker
J A
JA
Cully
E L
EL
Ross
A D
AD
Naik
D000203:Activities of Daily Living / Q000523:psychology*; D000342:Affective Symptoms / Q000097:blood / Q000209:etiology*; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology*; D001786:Blood Glucose / Q000378:metabolism; D003863:Depression / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D012648:Self Care / Q000523:psychology*; D020377:Self Efficacy; D013315:Stress, Psychological / Q000209:etiology
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human