Self‐reported diabetes self‐management competence and support from healthcare providers in achieving autonomy are negatively associated with diabetes distress in adults with Type 1 diabetes

Abstract

AimTo investigate the associations of self‐perceived competence in diabetes management and autonomy support from healthcare providers with diabetes distress in adults with Type 1 diabetes mellitus that is not optimally controlled [HbA1c ≥ 64 mmol/mol (8.0%)].MethodsThis cross‐sectional study comprised blood sampling and three self‐report questionnaires, the Problem Areas in Diabetes scale, the Perceived Competence in Diabetes Scale and a measure of autonomy support by healthcare providers, the Health Care Climate Questionnaire. We fitted blockwise linear regression models to assess the associations between Problem Areas in Diabetes score and the variables of interest (autonomy support and perceived diabetes competence), controlling for clinical and sociodemographic variables.ResultsOf the study sample [n = 178; mean age 36.7 (±10.7) years], 31.5% had long‐term complications and 43.2% reported elevated (≥40) Problem Areas in Diabetes scores. A significant negative association was found between autonomy support and Problem Areas in Diabetes score (B = ‐3.61, P = 0.001), indicating that lower autonomy support was associated with greater diabetes distress. When perceived competence was controlled, it mediated the association of autonomy support with diabetes distress, reducing it to non‐significance. There was a significant negative association between perceived competence and Problem Areas in Diabetes score (B = ‐8.89, P < 0.001), indicating that lower perceived competence was associated with greater perceived distress.ConclusionsThere was an indirect (fully mediated) relationship between autonomy support and diabetes distress; autonomy support was associated with increased perceived competence, which, in turn, was associated with reduced distress. Healthcare providers' communication styles enhancing perceived competence through autonomy support may contribute to effective treatment for people with Type 1 diabetes and suboptimum glycaemic control.

The effect of guided self-determination on self-management in persons with type 1 diabetes mellitus and HbA1c≥64 mmol/mol: a group-based randomised controlled trial

“… 14 In a cross-sectional study, HCPs being autonomy supportive were associated with the perceived level of diabetes distress mediated through the perceived level of diabetes competence. 23 In the current study, and incongruent with prior research on the GSD approach, 18 19 there was no change in HCP autonomy support (HCCQ) and level of diabetes competence (PCDS). However, GSD increased autonomous motivation (TSRQ autonomy) and reduced diabetes distress.…”

“…Further details on inclusion and exclusion criteria are outlined elsewhere. 23 A prestudy power calculation for a t-test assuming a 0.05 significance level and a power of 0.8 expecting 25% dropout and a difference of 0.6% change in HbA 1c (SD 1.3) between groups led to 218 participants needed to include. Expected change in HbA 1c was based on clinical relevance.…”

Standardizing Clinically Meaningful Outcome Measures Beyond HbA1c for Type 1 Diabetes: A Consensus Report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange

“…Measures that capture PROs can fill these important information gaps. A variety of validated measures (including surveys and questionnaires) of some PROs for youth and adults with type 1 diabetes are available and are used in clinical studies, including those for diabetes distress ( 76 ) and fear of hypoglycemia ( 77 ). Work to further develop and validate tools and measures for diabetes health-related quality of life is ongoing.…”

Premarriage counseling in Type 1 diabetes

“…Health literacy, patient empowerment, and a positive patient attitude are vital to achieving good outcomes and are associated with significantly less diabetes-related distress and perceived stigmatization and improved quality of life. [ 16 17 18 19 ] A well-motivated individual feels more confident and in control of every situation, including social interactions and interpersonal relationships. Therefore, health-care providers should encourage patient education and patient autonomy.…”