Reductions in Regimen Distress Are Associated With Improved Management and Glycemic Control Over Time
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OBJECTIVE: Cross-sectional and longitudinal associations among regimen distress (RD), self-management, and glycemic control were undertaken to explore mechanisms of operation among these variables. RESEARCH DESIGN AND METHODS: In a behavioral randomized control trial (RCT) to reduce RD, 392 adults with type 2 diabetes were assessed for RD, diet, exercise, medication adherence, and HbA1c at baseline and at 4 and 12 months. Associations among RD, self-management, and HbA1c were examined in cross-sectional analyses at baseline, in prospective analyses using baseline values to predict change over time, and in time-varying analyses. RESULTS: At baseline, greater RD and poorer medication adherence were independently associated with higher HbA1c (P = 0.05 and P < 0.001, respectively), and greater RD was associated with poorer medication adherence (P = 0.03). No consistent pattern of significant prospective associations was found. Significant time-varying findings showed that decreases in RD were associated with improvements in medication adherence (P < 0.01), physical activity (P < 0.001), and HbA1c (P = 0.02) over time following intervention. Changes in self-management were not associated with changes in HbA1c over time. CONCLUSIONS: In the context of an RCT to reduce distress, RD, self-management, and HbA1c were interrelated in cross-sectional and time-varying analyses. Decreases in RD were associated with improvements in both self-management and HbA1c over 12 months. Findings point to the complex and likely multifaceted pathways of association among these key constructs, with results indicating significant linkages between RD and both self-management and glycemic control over time.
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Diabetes distress is distinct from clinical depression and is directly linked to poor glycemic control and problematic self-care behaviors.
“Taken together, the emotional and behavioral challenges generated by diabetes and its management have been labeled “diabetes distress” (DD), which has been found to be distinct from clinical depression and, unlike depression, has been directly linked to poor glycemic control and problematic self-care behaviors”
From Understanding the sources of diabetes distress in adults with type 1 diabetes (2015) · cites this paper as D. H. Hessler et al., 2014
Changes in missed insulin boluses do not explain the association between diabetes distress and HbA1c, suggesting multiple mechanisms.
“changes in missed insulin boluses did not explain the association between diabetes distress and HbA1c, supporting the view that there are likely multiple mechanisms at work that may differ for subgroups of participants [2].”
From Diabetes distress is linked with worsening diabetes management over time in adults with type 1 diabetes (2017) · cites this paper as [2]
In adults with Type 2 diabetes, decreases in diabetes distress were bidirectionally associated with decreases in HbA1c, without support for one construct exclusively influencing the other.
“In both observational and intervention contexts with adults with Type 2 diabetes, we found that decreases in distress were bidirectionally associated with decreases in HbA1c, without support for one construct exclusively influencing the other [2,12].”
From Diabetes distress is linked with worsening diabetes management over time in adults with type 1 diabetes (2017) · cites this paper as [2]
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- Authors
- Hessler, D., Fisher, L., Glasgow, R. E., Strycker, L. A., Dickinson, L. M., Arean, P. A., & Masharani, U.
- Affiliations
- University of California, San Francisco (US)
- National Cancer Institute (US)
- Oregon Research Institute (US)
- University of Colorado Denver (US)
- University of California, San Francisco, San Francisco, CA
- Corresponding author
- Hessler, Danielle
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2014-02-11
- Volume
- 37
- Issue
- 3
- Pages
- 617-624
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC3931383
- OpenAlex
- W2116732998
- Cited by
- 102
- References
- 36
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 10 · 2023: 4 · 2022: 10 · 2021: 13 · 2020: 8 · 2019: 6 · 2018: 13 · 2017: 11 · 2016: 7 · 2015: 11 · 2014: 3
- FWCI
- 5.52
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by-nc-nd)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-061937, R01DK061937)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 2 diabetes, glycemic control, HbA1c, self-management, medication adherence, physical activity, diet, behavioral interventions, mechanisms of change
- MeSH terms
- Adult, Aged, Blood Glucose, Clinical Protocols, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Prospective Studies, Self Care, Stress, Psychological, Treatment Outcome, Medication Adherence
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