Relationships between dispositional mindfulness, health behaviors, and hemoglobin A1c among adults with type 2 diabetes.

Examine cross-sectional relationships between dispositional mindfulness and diabetes self-care behaviors (i.e., medication adherence, diet and exercise behavior, and self-monitoring of blood glucose; SMBG), hemoglobin A1c (HbA1c, %), and body mass index (BMI; continuously and obese vs. not). Adults with type 2 diabetes (N = 148, Mage = 55.7 ± 10.1) who were recruited to participate in a web-based diabetes medication adherence intervention completed all assessments at enrollment. In unadjusted analyses, mindfulness was associated with better dietary habits and worse HbA1c (p < .05). After controlling for a priori covariates (demographics, years since diabetes diagnosis, and insulin status), mindfulness remained associated with better dietary behavior (p < .01) but not HbA1c. Mindfulness was not associated with medication adherence, exercise behavior, SMBG, or body mass index. We found evidence that dispositional mindfulness plays an important role in dietary behaviors, supporting the use of mindful eating techniques in diabetes self-management interventions. Fostering mindfulness may be one of several behavioral tools needed to support key self-care behaviors and improve HbA1c.

Medication adherence may be more important than other behaviours for optimizing glycaemic control among low-income adults.

WHAT IS KNOWN: Patients with type 2 diabetes mellitus (T2DM) are required to perform multiple self-care behaviours to achieve and maintain optimal glycaemic control (HbA1c), which prevents complications and premature mortality. Patients with T2DM and low socioeconomic status (SES) are more likely to have suboptimal HbA1c, often due to being less adherent to recommended self-care activities than their higher-SES counterparts. OBJECTIVE: Although studies support performing certain diabetes self-care behaviours for optimizing glycaemic control, there is limited research on the relative importance of each behaviour for this purpose. Identifying what behaviours are most important for HbA1c among low-SES patients with T2DM would be particularly useful for informing policy and intervention efforts for this high-risk group. METHODS: In a cross-sectional study of 314 adults with T2DM and low SES, we used the Summary of Diabetes Self-Care Activities to assess self-care behaviours and multivariate models to test which behaviours were associated with lower HbA1c. RESULTS AND DISCUSSION: Only medication adherence was significantly associated with lower HbA1c after adjusting for the other self-care behaviours (ß = -0·14, P = 0·028) and further adjusting for demographic and diabetes characteristics (ß = -0·16, P = 0·024). WHAT IS NEW: Medication adherence may be the most important self-care behaviour for glycaemic control among adults with T2DM and low SES. CONCLUSION: Focused efforts to improve medication adherence among low-SES patient populations may improve glycaemic control.

Food insecurity is associated with diabetes self-care behaviours and glycaemic control.

AIMS: Food insecurity is the 'limited or uncertain availability of nutritionally adequate and safe foods'. Our objective was to examine the association between food insecurity, diabetes self-care and glycaemic control. METHODS: We conducted a cross-sectional analysis of baseline data from adult patients with Type 2 diabetes who were enrolled in a randomized trial evaluating a health literacy-focused diabetes intervention in safety net primary care clinics in middle Tennessee. Food insecurity was assessed with three items from the U.S. Household Food Security Survey. Diabetes self-care behaviours were assessed with the Summary of Diabetes Self-Care Activities Scale, Personal Diabetes Questionnaire and Adherence to Refills and Medication Scale. Glycaemic control was assessed with HbA1c . RESULTS: The sample consisted of 401 participants, 73% of whom reported some level of food insecurity. Food insecurity was significantly associated with self-care behaviours including less adherence to a general diet [Adjusted Odds Ratio (AOR) 0.9, P = 0.02], less physical activity (AOR 0.9, P = 0.04) and with a greater occurrence of medication non-adherence (AOR 1.2, P = 0.002) and calorie restriction (AOR 1.1, P = 0.02). Food insecurity was also associated with worse glycaemic control (adjusted ß = 0.1, P = 0.03). None of the self-care behaviours were significantly associated with HbA1c , limiting the ability to test for self-care as a mechanism linking food insecurity to glycaemic control. CONCLUSIONS: There was a high rate of food insecurity in a sample of patients with Type 2 diabetes who were of low socio-economic status. Food insecurity was associated with less adherence to recommended self-care behaviours and worse glycaemic control.

Lifetime depression and diabetes self-management in women with Type 2 diabetes: a case-control study.

AIMS: Little is known about the association between lifetime history of major depressive disorder (L-MDD) and diabetes self-management, particularly when depression is remitted. We examined the association between L-MDD and diabetes self-management in women with Type 2 diabetes who were not depressed at the time of assessment. METHODS: L-MDD was assessed with structured psychiatric interview. Participants completed paper-and-pencil measures of demographics, diabetes-related distress, self-care behaviours, healthcare utilization and diabetes self-efficacy. RESULTS: One-hundred and fifty-three women participated; 41% had L-MDD. Compared with their never-depressed counterparts, women with L-MDD had more diabetes distress, reported lower overall rates of self-monitoring of blood glucose (SMBG) and greater tendency to skip SMBG, had lower diet adherence and were less likely to have seen a primary care provider in the past year. Diabetes self-efficacy mediated the relationship between L-MDD and self-management. CONCLUSIONS: Interventions to promote self-management for patients with L-MDD may be warranted.