Affective symptoms and change in diabetes self-efficacy and glycaemic control

Authors

  • S. M. Robertson,

    Corresponding author
    1. Department of Medicine, Baylor College of Medicine, University of Houston, Houston, TX, USA
    • Houston Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, University of Houston, Houston, TX, USA
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  • A. B. Amspoker,

    1. Houston Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, University of Houston, Houston, TX, USA
    2. Department of Medicine, Baylor College of Medicine, University of Houston, Houston, TX, USA
    3. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, University of Houston, Houston, TX, USA
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  • J. A. Cully,

    1. Houston Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, University of Houston, Houston, TX, USA
    2. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, University of Houston, Houston, TX, USA
    3. VA South Central Mental Illness Research, Education and Clinical Center, University of Houston, Houston, TX, USA
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  • E. L. Ross,

    1. Houston Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, University of Houston, Houston, TX, USA
    2. Department of Psychology, University of Houston, Houston, TX, USA
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  • A. D. Naik

    1. Houston Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, University of Houston, Houston, TX, USA
    2. Department of Medicine, Baylor College of Medicine, University of Houston, Houston, TX, USA
    3. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, University of Houston, Houston, TX, USA
    4. VA South Central Mental Illness Research, Education and Clinical Center, University of Houston, Houston, TX, USA
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Correspondence to: Suzanne M. Robertson. E-mail: smr1@bcm.tmc.edu

Abstract

Aims

To examine the role of baseline depression, anxiety and stress symptoms on post-intervention diabetes self-efficacy and glycaemic control (HbA1c).

Methods

The current study analysed data from patients (n = 85) with treated but uncontrolled Type 2 diabetes who participated in a comparative effectiveness study of two diabetes self-management interventions. Hierarchical linear regression was used to examine the relationships between baseline affective symptoms and post-intervention diabetes self-efficacy and the moderating effects of baseline affective symptoms on the relationship between changes in diabetes self-efficacy and post-intervention HbA1c.

Results

Baseline depression was inversely associated with post-intervention diabetes self-efficacy (P = 0.0001) after adjusting for baseline characteristics including diabetes self-efficacy. In contrast, normal–mild levels of stress were associated with higher post-intervention diabetes self-efficacy (P = 0.04). Anxiety and stress symptoms significantly and independently moderated the relationship between changes in diabetes self-efficacy and post-intervention HbA1c (P = 0.02 and P = 0.03, respectively). Further evaluation of these interactions demonstrated that changes in diabetes self-efficacy were associated with lower post-intervention HbA1c, but only among those with higher baseline affective symptoms.

Conclusions

We found a moderating effect across affective symptoms on the relationship between diabetes self-efficacy changes and post-intervention HbA1c in the context of a self-management intervention. Results suggest that patients with poorly controlled diabetes who have higher levels of depression, anxiety and stress symptoms may derive greater benefits from self-management interventions known to improve diabetes self-efficacy.

Ancillary