1 Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada; CRCHUM, Montréal, Québec, Canada.
2 Department of Psychology , Université du Québec à Montréal , Montréal, Québec , Canada.
3 CRCHUM, Montréal, Québec, Canada; Department of Family and Emergency Medicine, Université de Montréal, Montréal, Québec, Canada.
4 CRCHUM, Montréal, Québec, Canada; Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada.
5 CRCHUM, Montréal, Québec, Canada; Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada.
6 CRCHUM, Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montréal, Québec, Canada.
7 PERFORM Centre, Concordia University, Montréal, Québec, Canada; Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.
8 Department of Social and Preventive Medicine , School of Public Health, Université de Montréal , Montréal, Québec , Canada.

Socioeconomic status and glycemic control in adult patients with type 2 diabetes: a mediation analysis.

BMJ Open Diabetes Res Care. 2016;4(1):e000184

Authors: Houle J, Lauzier-Jobin F, Beaulieu MD, Meunier S, Coulombe S, Côté J, Lespérance F, Chiasson JL, Bherer L, Lambert J

Abstract

OBJECTIVE: The purpose of this study is to examine the contribution of health behaviors (self-management and coping), quality of care, and individual characteristics (depressive symptoms, self-efficacy, illness representations) as mediators in the relationship between socioeconomic status (SES) and glycemic control.

METHODS: A sample of 295 adult patients with type 2 diabetes was recruited at the end of a diabetes education course. Glycemic control was evaluated through glycosylated hemoglobin (HbA1c). Living in poverty and education level were used as indicators of SES.

RESULTS: Bootstrapping analysis showed that the significant effects of poverty and education level on HbA1c were mediated by avoidance coping and depressive symptoms. The representation that diabetes is unpredictable significantly mediated the relationship between living in poverty and HbA1c, while healthy diet mediated the relationship between education level and HbA1c.

CONCLUSIONS: To improve glycemic control among patients with low SES, professionals should regularly screen for depression, offering treatment when needed, and pay attention to patients' illness representations and coping strategies for handling stress related to their chronic disease. They should also support patients in improving their self-management skills for a healthy diet.

PMID: 27239316 [PubMed]