Reductions in Regimen Distress Are Associated With Improved Management and Glycemic Control Over Time
Reductions in Regimen Distress Are Associated With Improved Management and Glycemic Control Over Time
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DOI：
10.2337/dc13-0762
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发表时间：
2014-03-01
期刊：
影响因子：
16.2
通讯作者：
Masharani, Umesh
中科院分区：
文献类型：
--
作者：
Hessler, Danielle;Fisher, Lawrence;Masharani, Umesh
目的研究方案困扰（RD）、自我管理和血糖控制之间的横断面和纵向关联，探讨这些变量之间的作用机制。研究设计和方法在一项旨在减少RD的行为随机对照试验（RCT）中，研究人员在基线、4个月和12个月时评估了392名2型糖尿病患者的RD、饮食、运动、药物依从性和HbA（1c）。在基线的横断面分析、使用基线值预测随时间变化的前瞻性分析和时变分析中，研究了RD、自我管理和HbA（1c）之间的关系。结果基线、较高的RD和较差的药物依从性与较高的HbA（1c）独立相关（P分别= 0.05和P < 0.001），较高的RD与较差的药物依从性相关（P = 0.03）。没有发现显著的前瞻性关联的一致模式。显著的时变研究结果显示，随着干预时间的推移，RD的降低与药物依从性（P < 0.01）、体力活动（P < 0.001）和HbA(1c) （P = 0.02）的改善有关。随着时间的推移，自我管理的改变与HbA（1c）的变化无关。结论：在一项旨在减少痛苦的随机对照试验中，RD、自我管理和HbA（1c）在横断面和时变分析中是相互关联的。在12个月内，RD的减少与自我管理和HbA（1c）的改善有关。研究结果指出，这些关键结构之间的关联途径复杂且可能是多方面的，结果表明，随着时间的推移，RD与自我管理和血糖控制之间存在显著联系。
OBJECTIVECross-sectional and longitudinal associations among regimen distress (RD), self-management, and glycemic control were undertaken to explore mechanisms of operation among these variables.RESEARCH DESIGN AND METHODSIn a behavioral randomized control trial (RCT) to reduce RD, 392 adults with type 2 diabetes were assessed for RD, diet, exercise, medication adherence, and HbA(1c) at baseline and at 4 and 12 months. Associations among RD, self-management, and HbA(1c) were examined in cross-sectional analyses at baseline, in prospective analyses using baseline values to predict change over time, and in time-varying analyses.RESULTSAt baseline, greater RD and poorer medication adherence were independently associated with higher HbA(1c) (P = 0.05 and P < 0.001, respectively), and greater RD was associated with poorer medication adherence (P = 0.03). No consistent pattern of significant prospective associations was found. Significant time-varying findings showed that decreases in RD were associated with improvements in medication adherence (P < 0.01), physical activity (P < 0.001), and HbA(1c) (P = 0.02) over time following intervention. Changes in self-management were not associated with changes in HbA(1c) over time.CONCLUSIONSIn the context of an RCT to reduce distress, RD, self-management, and HbA(1c) were interrelated in cross-sectional and time-varying analyses. Decreases in RD were associated with improvements in both self-management and HbA(1c) over 12 months. Findings point to the complex and likely multifaceted pathways of association among these key constructs, with results indicating significant linkages between RD and both self-management and glycemic control over time.