Abstract
Aims
The present study examined the mediating role of diabetes distress on the relationship between coping and glycaemic control, and evaluated if the afore-mentioned mediation was moderated by insulin treatment in people with type 2 diabetes.
Methods
A total of 473 adults with type 2 diabetes were recruited from an outpatient clinic in Hong Kong and invited to take part in a survey that measured adaptive coping, maladaptive coping, and diabetes stress. Glycaemic control was measured by glycated haemoglobin values extracted from medical records. PROCESS v3.4 macro was used to test the moderated mediation model.
Results
Adaptive coping was negatively associated with diabetes distress (−0.29, 95% CI: −0.53, −0.06), whereas maladaptive coping was positively associated with diabetes distress (1.82, 95% CI: 1.12, 2.51). Diabetes distress had a positive relationship with glycated haemoglobin (0.04, 95% CI: 0.02, 0.05), but no correlations were found between glycated haemoglobin and adaptive coping or maladaptive coping. Insulin treatment not only weakened the diabetes distress-glycaemic control relationship (−0.04, 95% CI: −0.06, −0.01), but also weakened the mediation effect of maladaptive coping-glycaemic control relationship via diabetes distress (−0.07, 95% CI: −0.12, −0.02).
Conclusions
The study findings revealed the role of diabetes distress and insulin treatment in the link between coping skills and glycaemic control. Interventions to help boost confidence and autonomy in people with diabetes could help them lessen diabetes distress.
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Data availability
The datasets analysed during the current study are not publicly available because of ethical restrictions (e.g. data contain potentially identifying patient information), but are available from the corresponding author on reasonable request.
References
International Diabetes Federation (2019) IDF diabetes atlas, 9th edn. Belgium, Brussels
American Diabetes Association. 6 (2018) Glycemic targets: standards of medical care in diabetes—2018. Diabetes Care 41(Supplement 1):S55-64
Fisher L, Mullan JT, Arean P, Glasgow RE, Hessler D, Masharani U (2010) Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care 33(1):23–28
Gahlan D, Rajput R, Gehlawat P, Gupta R (2018) Prevalence and determinants of diabetes distress in patients of diabetes mellitus in a tertiary care centre. Diabetes Metab Syndr Clin Res Rev 12(3):333–336
Skinner TC, Joensen L, Parkin T (2019) Twenty-five years of diabetes distress research. Diabetic Med 37:393–400
Fisher L, Glasgow RE, Strycker LA (2010) The relationship between diabetes distress and clinical depression with glycemic control among patients with type 2 diabetes. Diabetes Care 33(5):1034–1036
Asuzu CC, Walker RJ, Williams JS, Egede LE (2017) Pathways for the relationship between diabetes distress, depression, fatalism and glycemic control in adults with type 2 diabetes. J Diabetes Complicat 31(1):169–174
Aikens JE (2012) Prospective associations between emotional distress and poor outcomes in type 2 diabetes. Diabetes Care 35(12):2472–2478
Gonzalez JS, Shreck E, Psaros C, Safren SA (2015) Distress and type 2 diabetes-treatment adherence: a mediating role for perceived control. Health Psychol 34(5):505–513
Samuel-Hodge CD, Watkins DC, Rowell KL, Hooten EG (2008) Coping styles, well-being, and self-care behaviors among african americans with type 2 diabetes. Diabetes Educ 34(3):501–510
Sperl-Hillen J (2011) Comparative effectiveness of patient education methods for type 2 diabetes: a randomized controlled trial. Arch Intern Med 171(22):2001
Karlsen B, Oftedal B, Bru E (2012) The relationship between clinical indicators, coping styles, perceived support and diabetes-related distress among adults with type 2 diabetes: Diabetes-related distress. J Adv Nurs 68(2):391–401
Iturralde E, Weissberg-Benchell J, Hood KK (2017) Avoidant coping and diabetes-related distress: pathways to adolescents’ type 1 diabetes outcomes. Health Psychol 36(3):236–244
Huang C-Y, Lai H-L, Chen C-I, Lu Y-C, Li S-C, Wang L-W et al (2016) Effects of motivational enhancement therapy plus cognitive behaviour therapy on depressive symptoms and health-related quality of life in adults with type II diabetes mellitus: a randomised controlled trial. Qual Life Res 25(5):1275–1283
Yu H, Liu J, Fan Y, Li C, Zhang L, Chen X et al (2016) Association between occupational stressors and type 2 diabetes among Chinese police officers: a 4-year follow-up study in Tianjin. China Int Arch Occup Environ Health 89(2):277–288
Kwan CML, Mullan JT, Chun KM, Kwong Y, Hsu L, Chesla CA (2014) Social relationships and health among chinese americans with diabetes: does age make a difference? Clin Gerontol 37(3):191–210
Lazarus RS, Folkman S (1984) Stress, appraisal, and coping. Springer, New York, p 445
Stanisławski K (2019) The coping circumplex model: an integrative model of the structure of coping with stress. Front Psychol 16(10):694
Duangdao KM, Roesch SC (2008) Coping with diabetes in adulthood: a meta-analysis. J Behav Med 31(4):291–300
Burns RJ, Deschênes SS, Schmitz N (2016) Associations between coping strategies and mental health in individuals with type 2 diabetes: Prospective analyses. Health Psychol 35(1):78–86
Shayeghian Z, Hassanabadi H, Aguilar-Vafaie ME, Amiri P, Besharat MA (2016) A randomized controlled trial of acceptance and commitment therapy for type 2 diabetes management: the moderating role of coping styles. PLoS ONE 11(12):e0166599
Miles SR, Khambaty T, Petersen NJ, Naik AD, Cully JA (2018) The role of affect and coping in diabetes self-management in rural adults with uncontrolled diabetes and depressive symptoms. J Clin Psychol Med Settings 25(1):55–65
Liu S-Y, Huang J, Dong Q-L, et al (2020) Diabetes distress, happiness, and its associated factors among type 2 diabetes mellitus patients with different therapies. Medicine 99(11):e18831
Bao H, Liu J, Ye J (2018) The Endocrinology Department of the People’s Hospital of Jinhua, Jinhua, China. Influencing factors of the diabetes distress among Chinese patients with type 2 diabetes mellitus. Psychiat Danub 30(4):459–465
Chen S-Y, Hsu H-C, Wang R-H, Lee Y-J, Hsieh C-H (2019) Glycemic control in insulin-treated patients with type 2 diabetes: empowerment perceptions and diabetes distress as important determinants. Biol Res Nurs 21(2):182–189
Nanayakkara N, Pease A, Ranasinha S et al (2018) Depression and diabetes distress in adults with type 2 diabetes: results from the Australian National Diabetes Audit (ANDA) 2016. Sci Rep 8(1):7846
Petrak F, Herpertz S, Stridde E, Pfützner A (2013) Psychological insulin resistance in type 2 diabetes patients regarding oral antidiabetes treatment, subcutaneous insulin injections, or inhaled insulin. Diabetes Technol Ther 15(8):702–710
Bockwoldt D, Staffileno BA, Coke L, Quinn L (2016) Perceptions of insulin treatment among African Americans with uncontrolled type 2 diabetes. J Transcult Nurs 27(2):172–180
Hofer R, Choi H, Mase R, Fagerlin A, Spencer M, Heisler M (2017) Mediators and moderators of improvements in medication adherence: secondary analysis of a community health worker-led diabetes medication self-management support program. Health Educ Behav 44(2):285–296
Carver CS (1997) You want to measure coping but your protocol’ too long: consider the brief cope. Int J Behav Med 4(1):92–100
Han Y, Hu D, Liu Y et al (2014) Coping styles and social support among depressed Chinese family caregivers of patients with esophageal cancer. Eur J Oncol Nurs 18(6):571–577
Qiu Y, Li S (2008) Stroke: coping strategies and depression among Chinese caregivers of survivors during hospitalisation. J Clin Nurs 17(12):1563–1573
Ivarsson A, Johnson U, Podlog L (2013) Psychological predictors of injury occurrence: a prospective investigation of professional Swedish soccer players. J Sport Rehabil 22(1):19–26
Slanbekova G, Chung MC, Abildina S, Sabirova R, Kapbasova G, Karipbaev B (2017) The impact of coping and emotional intelligence on the relationship between posttraumatic stress disorder from past trauma, adjustment difficulty, and psychological distress following divorce. J Mental Health 26(4):334–341
Ting RZW, Nan H, Yu MWM et al (2011) Diabetes-related distress and physical and psychological health in chinese type 2 diabetic patients. Diabetes Care 34(5):1094–1096
Okumu M, Mengo C, Ombayo B, Small E (2017) Bullying and HIV risk among high school teenagers: the mediating role of teen dating violence. J School Health 87(10):743–750
Hayes AF, Montoya AK, Rockwood NJ (2017) The analysis of mechanisms and their contingencies: PROCESS versus structural equation modeling. Aust Mark J (AMJ) 25(1):76–81
Hayes AF (2013) Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. The Guilford Press, New York, p 507 (Methodology in the social sciences)
Hsu WC, Lau KHK, Huang R et al (2016) Utilization of a cloud-based diabetes management program for insulin initiation and titration enables collaborative decision making between healthcare providers and patients. Diabetes Technol Ther 18(2):59–67
D’Eramo Melkus G, Chyun D, Vorderstrasse A, Newlin K, Jefferson V, Langerman S (2010) The effect of a diabetes education, coping skills training, and care intervention on physiological and psychosocial outcomes in black women with type 2 diabetes. Biol Res Nurs 12(1):7–19
Fisher L, Hessler D, Polonsky WH et al (2018) T1-REDEEM: a randomized controlled trial to reduce diabetes distress among adults with type 1 diabetes. Diabetes Care 41(9):1862–1869
Folkman S, Lazarus RS (1980) An analysis of coping in a middle-aged community sample. J Health Soc Behav 21(3):219
Skinner EA, Edge K, Altman J, Sherwood H (2003) Searching for the structure of coping: a review and critique of category systems for classifying ways of coping. Psychol Bull 129(2):216–269
Fisher L, Polonsky WH, Hessler D (2019) Addressing diabetes distress in clinical care: a practical guide. Diabetic Med 36:803–812
Funding
This study was supported by Health and Medical Research Fund, Food and Health Bureau, The Government of Hong Kong SAR, China (Reference number 12130751). The funder did not take part in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.
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All authors contributed to the study conception and design. Material preparation and data collection were performed by VC. Data analysis was performed by CYKL. The first draft of the manuscript was written by CYKL, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The study was approved by the joint Chinese University of Hong Kong- New Territories East Cluster Clinical Research Ethics Committee, and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.
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Written informed consent forms were obtained from all participants included the study.
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Lau, C.Y.K., Kong, A.P.S., Lau, J.T.F. et al. Coping skills and glycaemic control: the mediating role of diabetes distress. Acta Diabetol 58, 1071–1079 (2021). https://doi.org/10.1007/s00592-021-01679-w
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DOI: https://doi.org/10.1007/s00592-021-01679-w