title: Do pre-existing diabetes social support or depressive symptoms influence the effectiveness of a diabetes management intervention?
abstract: OBJECTIVE
  Examine influences of diabetes-specific social support (D-SS) and depressive symptoms on glycemic control over time, among adults randomized to a diabetes self-management education and support (DSME/S) intervention or usual care.
  
  
  METHODS
  Data were from 108 African-American and Latino participants in a 6-month intervention trial. Multivariable linear regression models assessed associations between baseline D-SS from family and friends and depressive symptoms with changes in HbA1c. We then examined whether baseline D-SS or depression moderated intervention-associated effects on HbA1c.
  
  
  RESULTS
  Higher baseline D-SS was associated with larger improvements in HbA1c (adjusted ΔHbA1c -0.39% for each +1-point D-SS, p=0.02), independent of intervention-associated HbA1c decreases. Baseline depressive symptoms had no significant association with subsequent HbA1c change. Neither D-SS nor depression moderated intervention-associated effects on HbA1c.
  
  
  CONCLUSIONS
  Diabetes self-management education and support programs have potential to improve glycemic control for participants starting with varying levels of social support and depressive symptoms. Participants starting with more support for diabetes management from family and friends improved HbA1c significantly more over 6 months than those with less support, independent of additional significant DSME/S intervention-associated HbA1c improvements. Social support from family and friends may improve glycemic control in ways additive to DSME/S.
authors.affiliation: University of Michigan Medical School, Department of Internal Medicine, USA; VA Ann Arbor Center for Clinical Management Research, USA. Electronic address: arosland@umich.edu.
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Rosland
authors.affiliation: University of Michigan School of Social Work, USA.
authors.forename: Edith
authors.initials: E
authors.lastname: Kieffer
authors.affiliation: University of Michigan School of Social Work, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Spencer
authors.affiliation: University of Michigan School of Social Work, USA.
authors.forename: Brandy
authors.initials: B
authors.lastname: Sinco
authors.affiliation: REACH Detroit Partnership, Detroit, USA.
authors.forename: Gloria
authors.initials: G
authors.lastname: Palmisano
authors.affiliation: University of Michigan School of Public Health, Department of Health Behavior and Health Education, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Valerio
authors.affiliation: University of Michigan School of Social Work, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Nicklett
authors.affiliation: University of Michigan Medical School, Department of Internal Medicine, USA; VA Ann Arbor Center for Clinical Management Research, USA; University of Michigan School of Public Health, Department of Health Behavior and Health Education, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
mesh_terms: D001741:Black or African American; D001786:Blood Glucose / Q000378:metabolism; D003863:Depression / Q000150:complications*; D003920:Diabetes Mellitus / Q000097:blood / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012944:Social Support; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Community health workers; Depression; Diabetes; Racial/ethnic minorities; Social support