title: Pathways for the relationship between diabetes distress, depression, fatalism and glycemic control in adults with type 2 diabetes.
abstract: The aim of this study was to examine the mechanism by which depressive symptoms, diabetes distress, and diabetes fatalism together influence diabetes outcomes using structured equation modeling.
  
  
  
  615 adults with type 2 diabetes were recruited from two primary care clinics in the southeastern United States. Psychosocial factors found to be associated with diabetes outcomes were measured using validated questionnaires. Structured equation modeling (SEM) was used to investigate the relationship between diabetes fatalism, depressive symptoms, diabetes distress, self-care and glycemic control.
  
  
  
  The final model (chi2(903)=24,088.91, p<0.0001, R2=0.93, RMSEA=0.05 and CFI=0.90) showed that higher diabetes distress was directly significantly related to a decreased self-care (r=-0.69, p<0.001) and increased HbA1c (r=0.69, p<0.001). There was no significant direct association between depressive symptoms or fatalism, and glycemic control or self-care. There was, however, an indirect association between increased depressive symptoms and increased fatalism, explained through the direct association with diabetes distress in that higher depressive symptoms (0.76, p<0.001) and higher fatalism (0.11, p<0.001) were significantly associated with higher diabetes distress.
  
  
  
  Diabetes distress serves as a pathway through which depressive symptoms and fatalism impact both glycemic control and self-care. In addition, pathways between diabetes distress and both self-care behaviors and glycemic control in patients with type 2 diabetes remained separate, suggesting the need to address both psychological and behavioral factors in standard diabetes care, rather than focusing on psychological care primarily through support for self-management and treatment of depression.
authors.affiliation: College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC, USA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Asuzu
authors.affiliation: Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA; Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA.
authors.forename: Rebekah J
authors.initials: RJ
authors.lastname: Walker
authors.affiliation: Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA; Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA.
authors.forename: Joni Strom
authors.initials: JS
authors.lastname: Williams
authors.affiliation: Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA; Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA. Electronic address: egedel@musc.edu.
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D000368:Aged; D001007:Anxiety / Q000150:complications* / Q000209:etiology / Q000523:psychology; D003131:Combined Modality Therapy / Q000009:adverse effects; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications* / Q000209:etiology / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000523:psychology / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D000072858:Psychosocial Support Systems; D000073278:Self-Management / Q000523:psychology; D015144:Southeastern United States; D013315:Stress, Psychological / Q000150:complications* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Depression; Diabetes; Diabetes distress; Fatalism; HbA1c