Can a Diabetes Self-management Program Improve Diabetes Distress? Analysis from a Randomized Clinical Trial

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a highly prevalent chronic disease and one of the leading causes of morbidity and mortality in the United States (US) and in West Virginia (WV), a mostly rural Appalachian state. West Virginia has the highest prevalence of diabetes (16.0%) in the nation. Furthermore, the prevalence of two common comorbidities of T2DM, i.e., obesity (38.1%) and hypertension (43.5%), is the highest and second highest in WV. Chronic diseases are frequently associated with psychological stress. Diabetes distress is psychological stress prevalent in T2DM individuals, which encompasses emotional stress and worries related to diabetes self-care regimen and complications on a day-to-day basis. T2DM individuals who experience diabetes distress have poor glycemic status due to nonadherence to diet, physical activity, medication regimen. Diabetes self-management education (DSME) programs are proven to help T2DM individuals improve diabetes outcomes. However, very few studies have assessed the impact of DSME programs on reducing diabetes distress. The Diabetes and Hypertension Self-Management Program (DHSMP), which combined three evidence-based, widely accepted, and scientifically acclaimed disease management programs was one of the first evidence-based 12 weeks randomized controlled trials (RCT) on diabetes self-management in WV. The DHSMP was a 12-week randomized control trial (RCT) non-pharmacological lifestyle intervention delivered by trained health coaches and experts. Eighty nine adults with comorbid T2DM and hypertension were randomized into the intervention (n=44) and 6-month, wait-listed control group (n=45). Eighty five and 81 participants completed the 12- and 24-week assessments with a completion rate of 91%. The program was implemented in two churches in Morgantown and Charleston, WV, in 2018-2019. Specific Aims: This doctoral research utilized data from the DHSMP to determine the effectiveness of DHSMP to reduce diabetes distress in T2DM individuals. Three aims were explored for this dissertation research. Aim 1 evaluated the impact of DHSMP on changes in diabetes distress among the participants at post-intervention (24 weeks) from the baseline; Aim 2 evaluated the predictors (demographic, clinical, and behavioral factors) and changes in diabetes distress at 12- and 24 weeks. Aim 3 had two sub-aims. Aim 3a explored DHSMP participants’ everyday lived experiences and challenges to managing diabetes and its related distress & Aim 3b explored the efficacy of DHSMP participation on the participants’ perceptions of program components that were deemed helpful for adherence to diabetes self-management behaviors and reducing diabetes-related distress. Methods: All participants completed baseline, 12- and 24-week assessments, which included anthropometrics, behavioral and clinical