title: Socioeconomic status and glycemic control in adult patients with type 2 diabetes: a mediation analysis.
abstract: OBJECTIVE
  The purpose of this study is to examine the contribution of health behaviors (self-management and coping), quality of care, and individual characteristics (depressive symptoms, self-efficacy, illness representations) as mediators in the relationship between socioeconomic status (SES) and glycemic control.
  
  
  METHODS
  A sample of 295 adult patients with type 2 diabetes was recruited at the end of a diabetes education course. Glycemic control was evaluated through glycosylated hemoglobin (HbA1c). Living in poverty and education level were used as indicators of SES.
  
  
  RESULTS
  Bootstrapping analysis showed that the significant effects of poverty and education level on HbA1c were mediated by avoidance coping and depressive symptoms. The representation that diabetes is unpredictable significantly mediated the relationship between living in poverty and HbA1c, while healthy diet mediated the relationship between education level and HbA1c.
  
  
  CONCLUSIONS
  To improve glycemic control among patients with low SES, professionals should regularly screen for depression, offering treatment when needed, and pay attention to patients' illness representations and coping strategies for handling stress related to their chronic disease. They should also support patients in improving their self-management skills for a healthy diet.
authors.affiliation: Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada; CRCHUM, Montréal, Québec, Canada.
authors.forename: Janie
authors.initials: J
authors.lastname: Houle
authors.affiliation: Department of Psychology , Université du Québec à Montréal , Montréal, Québec , Canada.
authors.forename: François
authors.initials: F
authors.lastname: Lauzier-Jobin
authors.affiliation: CRCHUM, Montréal, Québec, Canada; Department of Family and Emergency Medicine, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Marie-Dominique
authors.initials: MD
authors.lastname: Beaulieu
authors.affiliation: Department of Psychology , Université du Québec à Montréal , Montréal, Québec , Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Meunier
authors.affiliation: Department of Psychology , Université du Québec à Montréal , Montréal, Québec , Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Coulombe
authors.affiliation: CRCHUM, Montréal, Québec, Canada; Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada.
authors.forename: José
authors.initials: J
authors.lastname: Côté
authors.affiliation: CRCHUM, Montréal, Québec, Canada; Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Lespérance
authors.affiliation: CRCHUM, Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Chiasson
authors.affiliation: PERFORM Centre, Concordia University, Montréal, Québec, Canada; Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Bherer
authors.affiliation: Department of Social and Preventive Medicine , School of Public Health, Université de Montréal , Montréal, Québec , Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Lambert
keywords: A1C; Coping; Depression; Low Income