Diabetes Medical Group Visits and Type 2 Diabetes Outcomes: A Mediation Analysis of Diabetes Distress (Preprint)

BACKGROUND Group-based diabetes care, both technology-enabled and in-person, can improve diabetes outcomes in low-income minority women, but the mechanism remains unclear. OBJECTIVE We tested whether diabetes medical group visits (DMGVs) reduced hemoglobin A1c (A1c) by mitigating diabetes distress, an emotional response affecting nearly half of adults with type 2 diabetes in community settings. METHODS We conducted a mediation and moderation analysis of data from the Women in Control 2.0 (WIC2) comparative effectiveness study, which showed that both technology-enabled and in-person DMGVs improve A1c. We tested whether diabetes distress mediated the relationship between DMGV engagement and reductions in A1c. We also tested whether this relationship was moderated by depressive symptoms and social support. Participants were 309 low-income and minority women. DMGV engagement was measured using the Group Climate questionnaire (GCQ-S). The mediator, diabetes distress, was measured using the Diabetes Distress Scale (DDS-17). The outcome was the 6-month change in A1c (A1c). Social support was measured using the Medical Outcomes Study Social Support Survey. RESULTS Diabetes distress mediated the relationship between engagement and 6-month A1c. Specifically, group engagement affected A1c by reducing distress associated with the emotional burden of diabetes (P = 0.09) and the regimen of diabetes self-management (P = 0.04). The relationship between engagement and 6-month A1c was moderated by depressive symptoms (P = 0.02), and social support (P = 0.08). CONCLUSIONS Engagement in DMGVs improved A1c because it helped reduce diabetes-related distress, especially related to the regimen of diabetes management and its emotional burden, and especially for women without depressive symptoms and who lacked social support. CLINICALTRIAL ClinicalTrials.gov NCT02726425; https://clinicaltrials.gov/ct2/show/NCT02726425