Self-efficacy, diabetes distress, self-management, and glycemic regulation: within-person pathways in type 1 diabetes

Background Despite extensive research on the role of self-efficacy in behavioral performance across various domains, its specific influence on self-management behaviors in type 1 diabetes (T1D) remains unclear. While studies find inconsistent evidence on whether self-efficacy actively drives future behaviors or is instead shaped by prior performance, research directly examining these temporal relationships in T1D is limited. Purpose This study aims to examine the within-person, bidirectional, temporal relationships among self-efficacy, diabetes distress, self-management behavior, and glycemic regulation in T1D using intensive longitudinal data. Methods The current analyses used data from the Function and Emotion in Everyday Life with Type 1 Diabetes study (N = 173). Participants wore a blinded continuous glucose monitor (CGM) for 14 days and completed 5-6 smartphone-based surveys daily. Data were analyzed using dynamic structural equation modeling. Results Diabetes self-efficacy, distress, and self-management were significantly related within-person. Morning self-efficacy predicted lower diabetes distress and better management, both of which improved CGM outcomes. Lagged analyses revealed that prior-day self-efficacy, distress, and self-management predicted next-morning self-efficacy, but prior-day glucose did not. Feedback from personal use of unblinded CGM did not influence these relationships. Conclusions Findings support self-efficacy as both an influence on future T1D self-management behavior change and an outcome of prior emotional states and self-management performance. Results suggest that diabetes self-efficacy predicts short-term glycemic regulation primarily through its associations with changes in diabetes distress and self-management.