The role of depression, stress and self-management behaviors on metabolic control in adults with type 2 diabetes

Background: Individuals with diabetes frequently experience depression and stress. However, studies on the relationship among depression, stress, and diabetes self-management behaviors and their potential contributions to metabolic control in adults, especially in Tricare beneficiaries with type 2 diabetes, have been limited.

Aims: To (1) determine the contributions of depression, stress, and self-management behaviors (e.g., diet, exercise) to metabolic control (hemoglobin A1c, triglycerides, high- and low-density lipoproteins) and (2) examine the associations among depression, stress, and diabetes self-management behaviors of Tricare beneficiaries with type 2 diabetes. Subjects and Methods: A cross-sectional research design of participants with type 2 diabetes (N=150) recruited from a military family medicine clinic. Data were collected from September 2012 to April 2013, using validated questionnaires for depression, stress, and self-management behaviors. Laboratory data were collected as measures of metabolic control. Data were analyzed using Pearson’s correlation and a general linear model.

Results: Depression, stress, and diabetes selfmanagement behaviors did not have significant contributions to metabolic biomarkers. However, depression was significantly and positively associated with stress(r = 0.72, p < 0.001), whereas selfmanagement behaviors were significantly and negatively associated with depression (r = -0.22, p = 0.006) and stress (r = -0.22, p = 0.006).

Conclusions: Although there were significant associations among depression, stress, and self- management behaviors, these factors did not appear to significantly influence metabolic control in this population. However, the potential impact of psychobehavioral factors on metabolic control needs to be further explored in more depressed and stressed populations using a longitudinal biobehavioral design.