Emotional Distress, Self-Management, and Glycemic Control among Participants enrolled in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) Study

Jeffrey S. Gonzalez, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA; New York-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, New York, USA. Electronic address: grademail@bsc.gwu.edu.
Heidi Krause-Steinrauf, The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD, USA.
Ionut Bebu, The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD, USA.
Gladys Crespo-Ramos, Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA.
Claire J. Hoogendoorn, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA.
Aanand D. Naik, School of Public Health, University of Texas Health Science Center, Houston, Texas, USA.
Andrea Waltje, University of Michigan, Ann Arbor, MI, USA.
Elizabeth Walker, Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA; New York-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, New York, USA.
Dominic Ehrmann, Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.
Janet Brown-Friday, Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA.
Andrea Cherrington, Department of Medicine (General Internal and Preventive Medicine) University of Alabama, Birmingham, Birmingham, AL, USA.

Document Type

Journal Article

Publication Date

12-19-2022

Journal

Diabetes research and clinical practice

DOI

10.1016/j.diabres.2022.110229

Keywords

Depression; diabetes-related distress; metformin; self-management; treatment adherence

Abstract

OBJECTIVE: We examined emotional distress in relation to metformin adherence, overall diabetes self-management, and glycemic control among adults with early type 2 diabetes (T2DM) enrolled in the GRADE study. METHODS: Linear regression models examined cross-sectional associations of baseline depression symptoms and diabetes distress with adherence to metformin, self-management, and HbA1c, adjusting for covariates. Cognitive-affective (e.g., sadness) and somatic (e.g., sleep/appetite disturbance) depression symptoms and diabetes distress subscales were also examined. RESULTS: This substudy of 1,739 GRADE participants (56% Non-Hispanic White, 18% Non-Hispanic Black, 17% Hispanic, 68% male, mean[SD] age=57.96[10.22] years, diabetes duration=4.21[2.81] years, and HbA1c=7.51[0.48]). The prevalence of clinically significant depression and diabetes distress was 8.7% and 25%, respectively. Fully adjusted models showed that depression symptoms were associated with lower self-management (p<0.0001); this effect was only significant for somatic symptoms. Diabetes distress was associated with lower adherence (p=0.0001) and self-management (p<0.0001); effects were significant for all subscales, except physician-related distress. No significant relationships of total depression symptom severity or diabetes distress with HbA1c were found. CONCLUSIONS: Depression symptoms and diabetes distress were robustly associated with problematic diabetes self-management among participants in GRADE. These findings highlight the need for routine assessment of depression symptoms and diabetes distress early in T2DM care.

Department

Biostatistics and Bioinformatics

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