The Effect of Depression on Poor Glycemic Control in Adults with Type 2 Diabetes: The Mediating Roles of Self-Efficacy and Self-Management Behaviors

Abstract

<b><i>Background:</i></b> High levels of depression and poor self-efficacy and self-management are associated with worse glycemic control, but the linkage and pathway between these variables are poorly understood. We conducted this study to investigate the hypothesis that self-efficacy and self-management mediate the influence of depression on poor glycemic control. <b><i>Methods:</i></b> We studied a purposive sample of 142 adults with type 2 diabetes attending a public clinic in Ilam, Iran. Hierarchical linear regression analysis and structural equation modeling were used to explore the relationships among the variables of interest. <b><i>Result:</i></b> Depression directly and negatively affects self-efficacy and indirectly affects self-management behaviors, which in turn have direct effects on hemoglobin A1c (HbA1c). Self-efficacy mediates the relationship between depression and self-management behaviors. Self-efficacy and self-management behaviors partially mediate the effect of depression on HbA1c. These results confirmed that the data fit the hypothesized model very well. <b><i>Conclusion:</i></b> Careful monitoring of glycemic control might be important in those individuals who exhibit clinical signs of depression. Effective treatment programs should probably pay close attention to not only screening and treatment of depression but also skills training to enhance patient self-efficacy and self-management of diabetes to improve HbA1c.

The relationship between patient empowerment and related constructs, affective symptoms and quality of life in patients with type 2 diabetes: a systematic review and meta-analysis

“…The relationship between empowerment-related constructs and depressive symptoms was reported in thirty-five studies ( n = 9315) ( 34 – 36 , 47 , 48 , 54 , 55 , 58 , 61 – 63 , 65 , 66 , 69 , 71 , 73 , 75 , 77 , 78 , 83 , 84 , 86 – 90 , 92 , 93 , 96 , 105 – 108 , 110 , 111 ). The most frequently used empowerment construct was self-efficacy ( n = 27) ( 35 , 54 , 55 , 58 , 61 – 63 , 65 , 66 , 69 , 71 , 73 , 75 , 77 , 78 , 80 , 83 , 84 , 86 – 90 , 92 , 93 , 96 , 105 , 106 ), followed by patient empowerment itself ( n = 4) ( 34 , 36 , 47 , 48 ), perceived control ( n = 2) ( 110 , 111 ) and patient activation ( n = 2) ( 107 , 108 ). Two studies were not included in the quantitative analysis due the lack of numerical data ( 65 , 83 ) and Sacco et al ( 92 ) was also excluded because its sample...…”

“…Through a MA including thirty correlation coefficients from twenty-nine original studies ( n = 8,990) ( 34 – 36 , 47 , 48 , 54 , 55 , 58 , 61 – 63 , 66 , 69 , 71 , 73 , 75 , 77 , 78 , 80 , 84 , 86 – 90 , 93 , 96 , 105 – 108 , 110 , 111 ), a weak-to-moderate inverse correlation was found ( r = −0.29; 95%CI −0.33 to −0.24; I 2 = 78.08%; k = 32) ( Figure 5 ).…”

Association between depression and HbA1c levels in the elderly population with type 2 diabetes mellitus during COVID-19 pandemic

“…Studies have also revealed that diabetic patients who had depression, and emotional problems-associated with diabetes, had significantly poorer control of HbA1c [18][19][20]. A study conducted in Iran (2019) showed that depression level was significantly related to glycemic control (HbA1c level) in which the worse the depression level, higher the HbA1c level [21]. Depression could activate adrenergic receptors located on macrophages because it can trigger psychological stress in the brain.…”

The Geriatric Depression Scale Predicts Glycemic Control in Older Adult with Type 2 Diabetes Mellitus: A Longitudinal Study

“…The link between depression and consequently hyperglycemia could be explained by self-management behaviors and self-efficacy. Higher depressive symptoms have been associated with fewer self-management behaviors and low self-efficacy, which has in turn been related to hyperglycemia [ 26 ].…”