Diabetes self-efficacy: Longitudinal relationships with diabetes overall self-management, medication non-adherence, diabetes distress, and glycemic control in adults with type 2 diabetes

Abstract

Abstract

Diabetes Self-Efficacy: Longitudinal Relationships with Diabetes Overall Self-Management, Medication Non-Adherence, Diabetes Distress, and Glycemic Control in Adults with Type 2 Diabetes

Purpose: To evaluate the longitudinal associations of diabetes self-efficacy with overall diabetes self-management, medication non-adherence, diabetes distress, and glycemic control.

Methods: This study performed secondary analyses among 812 predominantly socioeconomically disadvantaged ethnic minority adults with uncontrolled type 2 diabetes mellitus (T2DM). Repeated study measures, including diabetes self-efficacy, overall self-management activities, medication non-adherence, diabetes distress, and hemoglobin A1c (HbA1c), were collected every six months for three assessments over 12 months. Multilevel regression investigated the difference in diabetes self-efficacy between the two study groups. Multivariate and multiple linear regressions examined bidirectional relationships of diabetes self-efficacy with overall diabetes self-management activities, medication non-adherence, and HbA1c. A pathway analysis examined hypothesized constructs mediating the relationship between diabetes self-efficacy at baseline and HbA1c at 12-month follow-up.

Results: An increase of 4.19 points in the intervention group was significant (95% CI = -6.08, -2.30; p < .001) over the study time for self-efficacy. The difference in the estimated mean regression slopes was 1.87 (95% CI = 0.52, 3.21; p = .006). Diabetes self-efficacy at baseline was a significant predictor of overall self-management (b = 0.27, 95% CI = 0.23, 0.32; p < .001) and medication non-adherence scores at 12 months (b = -0.03, 95% CI = -0.04, -0.02; p < .001). Overall diabetes self-management at baseline was a significant predictor of diabetes self-efficacy (b = 0.35, 95% CI = 0.28, 0.42; p < .001) and diabetes self-efficacy at 12 months (b = -1.00, 95% CI = -1.33, -0.67; p < .001). There was a significant indirect effect of self-efficacy at baseline on HbA1c at 12-month follow-up through medication non-adherence at 6-month follow-up (ab = -0.005, 95% CI = -0.007, -0.003; p < .001). Abstract