Improvement in glycemic control following a diabetes education intervention is associated with change in diabetes distress but not change in depressive symptoms

J Behav Med. 2012 Jun;35(3):299-304. doi: 10.1007/s10865-011-9359-z. Epub 2011 Jun 21.


In diabetes patients, depression is correlated with diabetes-specific emotional distress, and observational studies have suggested that diabetes distress may have a greater impact on diabetes outcomes than depression itself. To examine the relative effects of change in depressive symptoms and change in diabetes distress on change in glycemic control, we conducted a diabetes self-management education intervention in 234 type 2 diabetes (T2DM) patients, and measured glycemic control (HbA1c), depressive symptoms (CES-D), and diabetes distress (PAID) at baseline and 6 months. In multiple linear regression, change in depressive symptoms was not associated with change in HbA1c (P=0.23). Change in diabetes distress was significantly associated with change in HbA1c (P<0.01), such that a 10-point decrease in diabetes distress (which corresponds to the average change in distress in this study population) was associated with a 0.25% reduction in HbA1c. Change in diabetes distress, and not change in depressive symptoms, was associated with both short- and long-term change in glycemic control for patients with poorly controlled T2DM.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Glucose
  • Depression / diagnosis*
  • Depression / psychology
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / psychology*
  • Female
  • Health Behavior
  • Humans
  • Male
  • Middle Aged
  • Patient Education as Topic*
  • Self Care*
  • Stress, Psychological / diagnosis*
  • Stress, Psychological / psychology


  • Blood Glucose