Reductions in Management Distress Following a Randomized Distress Intervention Are Associated With Improved Diabetes Behavioral and Glycemic Outcomes Over Time.
Reductions in Management Distress Following a Randomized Distress Intervention Are Associated With Improved Diabetes Behavioral and Glycemic Outcomes Over Time.
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DOI：
10.2337/dc20-2724
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发表时间：
2021-07
期刊：
影响因子：
16.2
通讯作者：
Fisher L
中科院分区：
文献类型：
--
作者：
Hessler D;Strycker L;Fisher L
在一项1型糖尿病（T1D）成人随机临床试验中，探讨糖尿病窘迫（DD）的减少与血糖结局的改善之间的关系。患有T1D的成人（N = 301）参加了一项旨在减少DD的两组试验（以DD为重点的OnTrack组与以教育为导向的KnowIt组）。平均年龄45.1岁；平均基线HbA1c为8.8% （73 mmol/mol）。在基线和9个月后对个体进行DD、自我保健、HbA1c和低血糖频率的评估。结构方程模型评估了总样本和干预组中DD、自我保健和血糖结局变化的假设途径。DD的减少与更好的自我保健显著且独立相关，包括更少的胰岛素遗漏，更频繁的胰岛素调整，改善的解决问题的能力，更多的血糖监测，更多地采用连续血糖监测（均P < 0.05）。反过来，更好的自我护理与更好的血糖结果有关，包括低血糖发作次数减少和HbA1c随着时间的推移而改善。拟合指标表明模型与数据拟合良好（验证性拟合指数= 0.94，近似均方根误差= 0.05），且OnTrack与KnowIt的关联更强、更有意义。在对T1D成人患者进行减少DD干预的背景下，结果表明，DD的减少并不直接影响血糖结局，而是通过改善自我护理行为。研究结果支持将疾病管理与DD干预相结合以最大限度地改善血糖结局的重要性。
To explore associations between reductions in diabetes distress (DD) and improvements in glycemic outcomes among adults with type 1 diabetes (T1D) in the context of a DD randomized clinical trial. Adults with T1D (N = 301) participated in a two-arm trial aimed at reducing DD (DD-focused OnTrack group vs. education-oriented KnowIt group). Mean age was 45.1 years; mean baseline HbA1c was 8.8% (73 mmol/mol). Individuals were assessed at baseline and 9 months later on DD, self-care, HbA1c, and frequency of hypoglycemia. Structural equation models evaluated hypothesized pathways among changes in DD, self-care, and glycemic outcomes in the total sample and by intervention group. Reductions in DD were significantly and independently associated with better self-care, including fewer missed insulin boluses, more frequent insulin adjustment, improved problem-solving skills, more blood glucose monitoring, and greater adoption of continuous glucose monitoring (all P < 0.05). In turn, better self-care was linked with better glycemic outcomes, including fewer episodes of hypoglycemia and improved HbA1c over time. Fit indices indicated good fit of the model to the data (confirmatory fit index = 0.94, root mean square error of approximation = 0.05), with stronger and more meaningful associations for OnTrack than for KnowIt. In the context of an intervention to reduce DD for adults with T1D, results indicate that reductions in DD do not affect glycemic outcomes directly but through improvements in self-care behavior. Findings support the importance of integrating disease management with DD interventions to maximize improvements in glycemic outcomes.
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影响因子：
3
作者：
Fisher L;Hessler D;Polonsky W;Strycker L;Masharani U;Peters A
通讯作者：
Peters A
影响因子：
3.9
作者：
Hill-Briggs, Felicia;Yeh, Hsin-Chieh;Brancati, Frederick L.
通讯作者：
Brancati, Frederick L.
影响因子：
2.5
作者：
Al Sayah, Fatima;Yeung, Roseanne O.;Johnson, Jeffrey A.
通讯作者：
Johnson, Jeffrey A.
影响因子：
16.2
作者：
Fisher, Lawrence;Hessler, Danielle;Strycker, Lisa A.
通讯作者：
Strycker, Lisa A.
影响因子：
16.2
作者：
Hessler, Danielle;Fisher, Lawrence;Masharani, Umesh
通讯作者：
Masharani, Umesh