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Purposes: Women with diabetes (WD) are more severely impacted by the consequence of suboptimal diabetes control. This study aims to examine the impact of demographic and disease characteristics, baseline self-stigma, role strain, diabetes distress on Hemoglobin A1C (A1C) levels, quality of life (D-QoL) and 6-month A1C levels in younger WD. Methods: This study was a 6-month prospective study. In total, 193 WD aged 20–64 years were selected by convenience sampling from three outpatient clinics in Taiwan. Demographic and disease characteristics, self-stigma, role strain, diabetes distress, A1C levels, and D-QoL were collected at baseline. A1C levels were further collected 6 months later. Structural equation modeling was conducted to test the hypothesized model. Results: The final model supported that higher baseline D-QoL directly associated with lower concurrent A1C levels and indirectly associated with lower 6-month A1C levels through baseline A1C levels. Higher baseline self-stigma, role strain, and diabetes distress directly associated with lower baseline D-QoL, and indirectly associated with higher 6-month A1C levels through D-QoL. Conclusion: Improving self-stigma, role strain, and diabetes distress should be considered as promising strategies to improve D-QoL in young WD. D-QoL plays a mediation role between baseline self-stigma, role strain, diabetes distress and subsequent glycemic control in younger WD. Enhancing baseline D-QoL is fundamental to improve subsequent glycemic control.

Abstract:Background: Depressive symptoms are associated with obesity, a precursor to type 2 diabetes and cardiovascular disease, and might in part explain the association of depressive symptoms with adverse metabolic outcomes. We determined the cross-sectional association between depressive symptoms and body mass index (BMI) and waist circumference (WC) in 1,314 elderly men and women age 60 to 83 years in the Atherosclerosis Risk in Communities (ARIC) Carotid MRI Study.Methods: Depressive symptoms were assessed using the Center for Epidemiological Studies Depression (CES-D) Scale. Elevated depressive symptoms were defined as CES-D score !16 and/or anti-depressant medication use. CES-D score was also modeled continuously.Results: In unadjusted analyses, each 5-point higher CES-D score was associated with a 0.48 kg/m 2 higher BMI (95% CI: 0.24 to 0.69) and a 1.23 cm higher WC (95% CI: 0.67 to 1.82). Adjustment for potential confounders, including physical activity, attenuated the associations with BMI (0.16 kg/m 2 ; 95% CI: -0.07 to 0.39) and WC (0.45 cm; 95% CI: -0.11 to 1.01). Compared to individuals without elevated depressive symptoms, those with elevated symptoms had significantly greater BMI (0.99 kg/m 2 ; 95% CI: 0.07 to 1.90) and WC (3.22 cm; 95% CI: 1.04 to 5.40), even after multivariable adjustment. In a subsidiary analysis, compared to individuals not taking anti-depressants, those taking anti-depressants had significantly higher waist circumference (1.54 cm; 95% CI: 0.18 to 2.90) and BMI (4.23 kg/m 2 ; 95% CI: 0.90 to 7.55) following multivariable adjustment. All results were similar when individuals with diabetes and coronary heart disease were excluded and when waist to height ratio was used an alternative measure of body fat. Conclusions:We found a significant cross-sectional association between depressive symptoms and BMI and WC in elderly individuals that was partially explained by health behaviors, particularly physical activity.