Distress and Type 2 Diabetes Self-Care: Putting the Pieces Together
Open accessAbstract
Background: Conflicting research emphasizes depression, diabetes distress, or well-being in relation to diabetes self-care and risk for poor health outcomes. Purpose: The purpose of this study was to test whether a latent variable for general psychological distress derived from shared variance of depression symptoms, diabetes distress, and well-being predicts a latent variable of diabetes self-care and to examine evidence for unique effects once shared effects are adjusted for. Methods: Adults with suboptimally controlled diabetes were recruited from the South Bronx, NY, for a telephonic diabetes self-management support trial. Baseline diabetes self-care, medication adherence, depression symptoms, diabetes distress, and well-being were measured by validated self-report. Structural equation modeling specified a latent variable for general psychological distress derived from shared variance of depression symptoms, diabetes distress, and well-being. Diabetes self-care was a latent variable indicated by diet, glucose self-monitoring, and medication adherence. Results: Participants (N = 627, 65% female) were predominantly ethnic minority (70% Hispanic; 45% Black) and 77% reported household income <$20K/year. Mean (standard deviation) age = 56 (12) years; A1c = 9.1% (1.9%); body mass index = 32 (8) kg/m2. The latent variable for psychological distress was a robust predictor of poorer diabetes self-care (coefficient = −0.59 [confidence interval = −0.71, −0.46], p < .001) with good model fit. Unique paths from depression symptoms, diabetes distress, and well-being (all ps > .99) to self-care were not observed. Conclusions: In this population of disadvantaged adults with suboptimally controlled diabetes, general psychological distress was strongly associated with poorer diabetes self-care and fully accounted for the effects of depression, diabetes distress, and positive well-being. This suggests that general distress may underlie previously reported associations between these constructs and diabetes self-care.
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High levels of diabetes distress are known to negatively affect self-care behaviors, medication adherence, and glycemic control.
“This finding is clinically important, as high levels of diabetes distress are known to negatively affect self-care behaviors, medication adherence, and glycemic control [40-42].”
From Evaluation of the Impact of Mobile Health App Vitadio in Patients With Type 2 Diabetes: Randomized Controlled Trial (2025) · cites this paper as [41]
The Introduction (page unavailable) reports research associating diabetes-related distress with problematic self-care and glycemic control, and the Abstract identifies medication adherence as part of the self-care measure. But the paper calls the literature inconclusive and finds that diabetes distress has no independent association with self-care after accounting for general psychological distress. These associations do not establish that high diabetes distress itself negatively affects all three outcomes. (LLM, conf=0.86)
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- Authors
- Hoogendoorn, C. J., Schechter, C. B., Llabre, M. M., Walker, E. A., & Gonzalez, J. S.
- Affiliations
- Yeshiva University (US)
- Albert Einstein College of Medicine (US)
- University of Miami (US)
- Corresponding author
- Hoogendoorn, Claire J
- Venue
- Annals of Behavioral Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-09-11
- Volume
- 55
- Issue
- 10
- Pages
- 938-948
- ISSN
- 0742-5554 (ISSN-L)
- 0883-6612
- 1532-4796
- PMC
- PMC8489306
- OpenAlex
- W3086578826
- Cited by
- 28
- References
- 65
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 8 · 2023: 3 · 2022: 3 · 2021: 4
- FWCI
- 1.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Annals of Behavioral Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R18 DK078077)
- Einstein-Mount Sinai Diabetes Research Center,
- Albert Einstein College of Medicine (P30 DK020541)
- New York Regional Center for Diabetes Translation Research (P30 DK111022)
- David and Jane Willner Bloomgarden Family Fellowship Fund (R01 DK104845, R18 DK098742, R01 DK121298, R01 DK121896)
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- diabetes self-care, psychological distress, diabetes distress, depression, well-being, medication adherence, self-monitoring of blood glucose, diet, Hispanic adults, ethnic minority health, diabetes self-management support, shared variance
- MeSH terms
- Ethnic and Racial Minorities, Adult, Depression, Diabetes Mellitus, Type 2, Ethnicity, Female, Humans, Male, Middle Aged, Minority Groups, Self Care, Stress, Psychological
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