Reductions In Regimen Distress Are Associated With Improved Management And Glycemic Control Over Time.
- Danielle Hessler, Ph.D.1⇑,
- Lawrence Fisher, Ph.D., ABPP1,
- Russell E. Glasgow, Ph.D.2,
- Lisa A. Strycker, M.A.3,
- L. Miriam Dickinson, Ph.D4,
- Patricia A. Arean, Ph.D.1 and
- Umesh Masharani, M.D.1
- 1University of California, San Francisco, CA, USA
- 2Implementation Science, Division of Cancer Control and Population Science, National Cancer Institute, Rockville, MD, USA
- 3Oregon Research Institute, Eugene, OR, USA
- 4University of Colorado, Denver, Aurora, CO, USA
- Corresponding Author: Danielle Hessler, E-mail:
Purpose Cross-sectional and longitudinal associations among regimen distress (RD), self-management, and glycemic control were undertaken to explore mechanisms of operation among these variables.
Methods In a behavioral randomized control trial (RCT) to reduce RD, 392 adults with type 2 diabetes were assessed on RD, diet, exercise, medication adherence, and HbA1c at baseline, and 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=.05 and p<.001 respectively), and greater RD was associated with poorer medication adherence (p=.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<.01), physical activity (p<.001), and HbA1c (p=.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 inter-related 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.
- Received March 30, 2013.
- Accepted September 15, 2013.
- © 2013 by the American Diabetes Association.
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