title: Serious Psychological Distress and Diabetes Management among American Indians and Alaska Natives.
abstract: OBJECTIVE
  Our study examined associations between serious psychological distress and blood glucose level (HbA1c) and body mass index (BMI) among American Indian and Alaska Native (AI/AN) participants in a cardiovascular disease prevention program.
  
  
  METHODS
  Using linear regression, we assessed the relationships between serious psychological distress and HbA1c and BMI at baseline and one year later. SETTING, PARTICIPANTS, AND INTERVENTION: AI/AN participants were aged 18 years, diagnosed with type 2 diabetes, and enrolled in the Special Diabetes Project for Indians Healthy Heart Project.
  
  
  METHODS
  Outcomes were percentage of HbA1c and BMI, measured at enrollment and first annual exam. Both outcomes were continuous measures in all analyses.
  
  
  RESULTS
  Serious psychological distress was associated at baseline with increased HbA1c in the unadjusted and adjusted models (adjusted b = .17%, P < 0.01). Serious psychological distress also was associated at baseline with increased BMI (.635 kg/m2, P = .01) and at one year with increased BMI (0.174 kg/m2, P = .01) in the unadjusted model. After adjustment for demographic and health characteristics, these relationships were no longer significant.
  
  
  CONCLUSIONS
  Cross-sectional baseline findings are consistent with existing literature. One-year findings suggest need for further inquiry into mediators of psychological distress and examination of additional diabetes-specific health outcomes. Additional years of observation may be needed to disentangle relationships between serious psychological distress and BMI.
authors.forename: Kimberly R
authors.initials: KR
authors.lastname: Huyser
authors.forename: Spero M
authors.initials: SM
authors.lastname: Manson
authors.forename: Lonnie A
authors.initials: LA
authors.lastname: Nelson
authors.forename: Carolyn
authors.initials: C
authors.lastname: Noonan
authors.forename: Yvette
authors.initials: Y
authors.lastname: Roubideaux
mesh_terms: D000413:Alaska; D015992:Body Mass Index; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000523:psychology* / Q000628:therapy; D004522:Educational Status; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012044:Regression Analysis; D013315:Stress, Psychological / Q000097:blood / Q000208:ethnology*
chemical_list: D006442:Glycated Hemoglobin