Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Peers for Progress, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, Chapel Hill, USA.
Diabet Med. 2023 Jul;40(7):e15065. doi: 10.1111/dme.15065. Epub 2023 Mar 16.
Diabetes distress is positively associated with HbA and may mediate the relationship between depressive symptoms and HbA . This study examined these relationships in a geographically, socioeconomically, and ethnically diverse sample of adults with type 2 diabetes.
Using data from five US sites evaluating peer support for diabetes management (n = 917), Structural Equation Modeling (SEM) examined whether diabetes distress (four items from Diabetes Distress Scale) mediated the relationship between depressive symptoms (PHQ-8) and HbA . Sites compared interventions of varying content and duration with control conditions. Time from Baseline Assessment to Final Assessment varied from six to 18 months. Site characteristics were controlled by entering site as a covariate along with age, sex, education, diabetes duration, insulin use, and intervention/control assignment.
Depressive symptoms, diabetes distress, and HbA were all intercorrelated cross-sectionally and from Baseline to Final Assessment (rs from 0.10 to 0.57; ps <0.05). In SEM analyses, diabetes distress at Final Assessment mediated the relationship between Baseline depressive symptoms and HbA at Final Assessment (indirect effect: b = 0.031, p < 0.001), controlling for Baseline HbA and covariates. Parallel analysis of whether depressive symptoms mediated the relationship between Baseline diabetes distress and HbA at Final Assessment was not significant.
In this diverse sample, diabetes distress mediated the influence of depressive symptoms on HbA but the reverse, depressive symptoms mediating the effect of distress, was not found. These findings add to the evidence that diabetes distress is a worthy intervention target to improve clinical status and quality of life among individuals with type 2 diabetes.
糖尿病困扰与 HbA 呈正相关，并且可能在抑郁症状与 HbA 之间的关系中起中介作用。本研究在具有 2 型糖尿病的地理、社会经济和种族多样化的成年人样本中检验了这些关系。
使用来自五个美国地点评估糖尿病管理同伴支持的数据（n=917），结构方程模型（SEM）检验了糖尿病困扰（糖尿病困扰量表的四个项目）是否在抑郁症状（PHQ-8）与 HbA 之间起中介作用。各地点将不同内容和持续时间的干预与对照条件进行比较。从基线评估到最终评估的时间从 6 到 18 个月不等。通过将地点作为协变量与年龄、性别、教育、糖尿病持续时间、胰岛素使用以及干预/对照分配一起输入，控制了地点特征。
抑郁症状、糖尿病困扰和 HbA 在横截面上以及从基线到最终评估时均相互关联（rs 从 0.10 到 0.57；p<0.05）。在 SEM 分析中，最终评估时的糖尿病困扰在基线抑郁症状与最终评估时的 HbA 之间起中介作用（间接效应：b=0.031，p<0.001），控制了基线 HbA 和协变量。关于抑郁症状是否在基线糖尿病困扰与最终评估时 HbA 之间起中介作用的平行分析不显著。
在这个多样化的样本中，糖尿病困扰中介了抑郁症状对 HbA 的影响，但没有发现抑郁症状中介了困扰对 HbA 的影响。这些发现增加了证据表明，糖尿病困扰是改善 2 型糖尿病患者临床状况和生活质量的一个值得干预的目标。
