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2019 HSR&D/QUERI National Conference Abstract

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1031 — Impact of Diabetes Distress on Hemoglobin A1c Levels in a Self-Management Diabetes Intervention

Lead/Presenter: Nipa Kamdar,  COIN - Houston
All Authors: Kamdar NP (Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC, Houston, Texas), Woodard LD (Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC, Houston, Texas), Amspoker AB (Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC, Houston, Texas) Odom EA (Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC, Houston, Texas) Naik AD (Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC, Houston, Texas)

Objectives:
As the prevalence of diabetes increases, helping veterans manage their diabetes is a priority. Empowering Patients in Chronic Care (EPIC) is a behavioral-change intervention that improves glycemic control using collaborative goal-setting methodology. Lowering diabetes distress is a possible mechanism for improving HbA1c levels. Diabetes distress is measured across four domains: emotional, physician-related, regime-related, and interpersonal distress. This study examined the impact of EPIC compared to usual care on HbA1c mediated by diabetes distress levels.

Methods:
We randomized 280 participants with uncontrolled diabetes to receive EPIC or usual care at five Veteran Affairs primary care clinics. We measured diabetes distress (using the 17-item Diabetes Distress Scale) and HbA1c levels at baseline and post-intervention. We assessed mediation using multiple linear regression and estimated indirect effects using 95% bootstrap confidence intervals.

Results:
Participants were predominantly male (94%) with a mean age of 67.2 (SD = 8.4) years. At baseline there was no difference between EPIC and usual care in diabetes distress (t(271) = 0.35, p = .72) or HbA1c (t(278) = -0.31, p = .75). Post-intervention diabetes distress partially mediated the relationship between treatment group and post-intervention HbA1c (indirect effect = -0.12, 95% CI [-0.24, -0.03]), controlling for baseline levels of depression, diabetes distress, HbA1c, and insulin use. Regime-related distress was the only subscale that partially mediated the relationship between treatment group and post-intervention HbA1c (indirect effect = -0.14, 95% CI [-0.25, -0.05]).

Implications:
EPIC participants had a greater reduction in diabetes distress (specifically regime-related distress) compared to usual care. This reduction contributed to a lower post-intervention HbA1c.

Impacts:
Consistent with VA's Whole Health approach to care, acknowledging and working with Veterans to manage the distress associated with diabetes contributes to improved HbA1c. Of the four types of distress, the distress related to regime management (medications and lifestyle) had the greatest impact.