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Randomized Controlled Trial
. 2013 May;30(5):e189-96.
doi: 10.1111/dme.12146.

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

S M Robertson  1 , A B Amspoker, J A Cully, E L Ross, A D Naik
Affiliations
Randomized Controlled Trial

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

S M Robertson et al. Diabet Med. 2013 May.

Abstract

Aims: To examine the role of baseline depression, anxiety and stress symptoms on post-intervention diabetes self-efficacy and glycaemic control (HbA(1c)).

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 HbA(1c).

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 HbA(1c) (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 HbA(1c), 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.

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Figures

Figure 1
Figure 1. Plots of the interactions between (a) baseline anxiety, (b) baseline depression and (c) baseline stress and change in diabetes self-efficacy predicting post-intervention HbA1c
(a) The simple slope of the relationship between change in diabetes self-efficacy and post-intervention HbA1c was significant for those with higher anxiety (β = −0.40, P = 0.02), but not for those with lower anxiety (β = 0.10, P = 0.44). (b) The simple slope of the relationship between change in diabetes self-efficacy and post-intervention HbA1c was marginally significant for those with higher depression (β = −0.33, P = 0.06), but not for those with lower depression (β = 0.10, P = 0.49). (c) The simple slope of the relationship between change in diabetes self-efficacy and post-intervention HbA1c was marginally significant for those with higher stress (β = −0.25, P = 0.06), but not for those with lower stress (β = 0.12, P = 0.37).
Figure 1
Figure 1. Plots of the interactions between (a) baseline anxiety, (b) baseline depression and (c) baseline stress and change in diabetes self-efficacy predicting post-intervention HbA1c
(a) The simple slope of the relationship between change in diabetes self-efficacy and post-intervention HbA1c was significant for those with higher anxiety (β = −0.40, P = 0.02), but not for those with lower anxiety (β = 0.10, P = 0.44). (b) The simple slope of the relationship between change in diabetes self-efficacy and post-intervention HbA1c was marginally significant for those with higher depression (β = −0.33, P = 0.06), but not for those with lower depression (β = 0.10, P = 0.49). (c) The simple slope of the relationship between change in diabetes self-efficacy and post-intervention HbA1c was marginally significant for those with higher stress (β = −0.25, P = 0.06), but not for those with lower stress (β = 0.12, P = 0.37).
Figure 1
Figure 1. Plots of the interactions between (a) baseline anxiety, (b) baseline depression and (c) baseline stress and change in diabetes self-efficacy predicting post-intervention HbA1c
(a) The simple slope of the relationship between change in diabetes self-efficacy and post-intervention HbA1c was significant for those with higher anxiety (β = −0.40, P = 0.02), but not for those with lower anxiety (β = 0.10, P = 0.44). (b) The simple slope of the relationship between change in diabetes self-efficacy and post-intervention HbA1c was marginally significant for those with higher depression (β = −0.33, P = 0.06), but not for those with lower depression (β = 0.10, P = 0.49). (c) The simple slope of the relationship between change in diabetes self-efficacy and post-intervention HbA1c was marginally significant for those with higher stress (β = −0.25, P = 0.06), but not for those with lower stress (β = 0.12, P = 0.37).
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