Glycemic Outcome Not Predicted by Baseline Psychological Measures in a Diabetes Management Program

Abstract

The Northern Health Diabetes Hospital Admission Risk Program is a chronic disease management program that aims to improve the glycemic management of patients with diabetes. The aim of this project was to determine if there was any relationship between psychological characteristics and glycemic outcome in a diabetes management program. A prospective study of patients attending the diabetes management program investigated validated measures of cognition, stage of change, locus of control, self-efficacy, depression and anxiety, and quality of life. The study investigated 86 type 2 diabetes patients (mean age 59 years, 49% female). Glycemic control (HbA1c) was measured at baseline and after 12 months in the program. Glycemic control was poor on admission to the service with a mean HbA1c of 8.9%. The measures of cognition, self-efficacy, locus of control, mental health, and quality of life were not associated with improvements in HbA1c. Those participants with shorter duration of disease and more contacts with the service were significantly more likely to experience improvements in HbA1c. Psychometric data were not predictive of glycemic outcome. Rather, in this chronic disease management program, glycemia improved more in patients who were seen earlier in their disease course and managed more intensively, regardless of their psychometric status.

Randomized controlled trial of a family-oriented self-management program to improve self-efficacy, glycemic control and quality of life among Thai individuals with Type 2 diabetes

“…No differences between the intervention and control arms were seen in both of these outcomes; however, in the risk-adjusted models, higher diabetes self-management scores significantly improved both physical and mental components of quality of life and also decreased HbA1c levels. Other studies have identified a poor relationship between reductions in HbA1C and improvements in self-efficacy and quality of life [48,49]. Further, a systematic review of diabetes self-management education, including 21 studies, found that the average baseline HbA1C before the intervention was 8.23% compared to our study baseline means of HbA1C of 6.3% (control) and 7% (intervention) [50], suggesting that, in this study, the sample was a group (intervention and control) with improved glycaemic control at baseline.…”

Depressive symptoms prior to and following insulin initiation in patients with type 2 diabetes mellitus: Prevalence, risk factors and effect on physician resource utilisation

“…Notably, the frequency of healthcare contact (adjusted for in our analysis) may have been overlooked as an important confounder in randomised studies comparing more intensive treatment with usual care [46,47]. Graco et al [28] found that glycaemia improved more in patients who were seen earlier in their disease course and were managed more intensively, regardless of their psychometric status.…”

“…These differences may be explained by confounding factors such as the use of insulin and the frequency of healthcare contact [28], the natural history and underlying cause of comorbid depression in diabetes [29], and the diagnostic overlap with other psychological problems such as anxiety and diabetes distress [30]. Papelbaum et al [31] reported higher levels of HbA 1c in T2DM patients with depression than those without mood disorder; however, HbA 1c levels were not higher in patients with a history of depression who were not depressed at the time of clinical evaluation.…”

A Worksite Occupational Health Clinic-Based Diabetes Mellitus Management Program

“…In a study of 86 patients with type 2 diabetes with an average baseline HbA1c of 8.9% indicating poor control, improved control was associated with being seen earlier in their disease course and more intense management regardless of their psychometric status. 34…”