Despite advances in diabetes self-management education and support (DSMES), disparities persist in clinical, behavioral, and psychosocial outcomes. Evidence suggests that, in addition to racial/ethnic disparities in diabetes self-management, gender disparities in glycemic control (A1c) exist in patients with type 2 diabetes (T2D). However, there is a knowledge gap in determining if gender differences in A1c are mediated by Diabetes Distress (DD) and/or Depressive Symptoms (DS), or if gender moderates this relationship. Therefore, we aimed to investigate the relationship between gender, DD, DS, and A1c in 94 African American adults with T2D from 9 churches in metro-Detroit, MI. All churches participated in a 15-month, cluster randomized controlled trial focused on DSMS efforts to maintain T2D outcomes following DSME. DD was defined as DD Scale score >=3. DS was measured with the PHQ-9. PHQ-9 was categorized into no DS (PHQ-9 score < 5), minimal DS (PHQ-9 score >=5<10), and depression (PHQ-9 scores >=10). Participants were 44% male, had a mean age of 65.0±10.46 years, and 32% were prescribed insulin. Mean baseline A1c was 7.1±1.7 (males: 7.4±2.0; females: 6.9±1.5, p=0.78). 34.4% of participants reported having DD. More females (35%) reported DD compared to males (31.2%) p=0.72. Approximately 63% of participants reported no DS, 21% reported minimal DS, and 16% reported having DS. There were no differences in PHQ-9 scores when stratified by gender (p=0.17). Mixed effects logistic regression revealed that gender did not moderate the relationship between DD or DS and A1c. However, DD mediated gender differences in A1c (β=-1.7, p=0.02) but DS did not (β=-0.25, p=0.76). Gender differences in a1c for patients with T2D may be attributable to DD, but not DS. As females traditionally report higher DD levels than males and a1c is often worse in males than females, increased attention to these gender differences is warranted, particularly among African Americans.
J. M. Hawkins: None. N. J. Koscielniak: None. R. Nwankwo: None. M. M. Funnell: Other Relationship; Self; American Diabetes Association. K. A. Kloss: None. D. Hall: None. G. Piatt: None.
National Institutes of Health (5R01DK10473305)