Impact of Distress Reduction on Behavioral Correlates and A1C in African American Women with Uncontrolled Type 2 Diabetes: Results from EMPOWER

Objective: Symptoms of emotional distress related to diabetes have been associated with inadequate self-care behaviors, medication non-adherence, and poor glycemic control that may predispose patients to premature death. African American women, in whom diabetes is more common and social support is often insufficient, may be at particularly high risk. The objective of this study was to examine the impact of lowering diabetes-re­lated emotional distress on glycemic control and associated behavioral correlates in rural African American women with uncontrolled type 2 diabetes (T2D). Design: Post-hoc analysis of prospective, randomized, controlled trial. Setting : Rural communities in the southeast­ern United States. Patients : 129 rural middle-aged African American women with uncontrolled type 2 diabetes (T2D)(A1C ≥ 7.0). Primary Independent Variable: Diabetes-related distress. Main Outcome Measures : Changes from baseline to 12-month follow-up in diabetes-related distress, and associated changes in medication adherence, self-care activities, self-efficacy, and glycemic control (A1C). Results : Patients with a reduction in diabe­tes-related distress (n=79) had significantly greater improvement in A1C, medication adherence, self-care activities, and self-effi­cacy compared with those in whom diabetes distress worsened or was unchanged (n=50). Changes in distress were also significantly and inversely correlated with improvements in medication adherence, self-care activities, and self-efficacy. Conclusions : Among rural African Ameri­can women, reductions in diabetes-related distress may be associated with lower A1C and improvements in self-efficacy, self-care behaviors, and medication adherence. Ethn Dis. 2017;27(2):155-160; doi:10.18865/ed.27.2.155.