Reductions in Regimen Distress Are Associated With Improved Management and Glycemic Control Over Time

OBJECTIVE: Cross-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 METHODS: In 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. RESULTS: At 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. CONCLUSIONS: In 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.