670-P: Self-Efficacy and Fatalism as a Pathway between Delay Discounting, Delay Aversion, and Glycemic Control

Background: Delay discounting (DD) is the cognitive process of comparing values between immediate and delayed rewards. Delay aversion (DA) refers to the negative emotional response when faced with a delay. Pathways between DD/DA and glycemic control are poorly understood. Based on prior evidence, self-efficacy and fatalism were hypothesized as key mechanisms through which DD/DA influences glycemic control.

Methods: Baseline data on 200 African Americans with T2DM enrolled in a diabetes intervention trial was analyzed. DD and DA were measured with the validated quick delay questionnaire, self-efficacy was measured with the validated perceived diabetes self-management scale, fatalism was measured using the validated diabetes fatalism scale, and glycemic control was measured via HbA1c. Structural equation modeling (SEM) was used to investigate the direct and indirect relationships between DD/DA and HbA1c via self-efficacy, and fatalism respectively using Stata V17.

Results: Sample mean age was 56.4 years, 33% were women, 61% had income <$25K, 31% were employed, and mean diabetes duration was 15 years. In the final SEM model for DD, self-efficacy was directly associated with HbA1c (r=-0.05; p<0.05). Fatalism was marginally associated with HbA1c (r=0.12; p<0.10). DD was significantly associated with self-efficacy (r=0.17; p<0.05) and fatalism (r=0.19; p<0.001). In the final SEM model for DA, self-efficacy was directly associated with HbA1c (r=-0.16; p<0.05) while fatalism was marginally associated with HbA1c (r=0.14; p<0.10). DA was significantly associated with self-efficacy (r=-0.27; p<0.001) and fatalism (r=0.32; p<0.001).

Conclusion: In African Americans with T2DM, delay discounting and delay aversion are associated with worse glycemic control indirectly via lower self-efficacy and marginally via higher diabetes fatalism. This study provides new evidence on potential mechanisms of action and potential pathways for interventions in this population.