Assessing the roles of diabetes empowerment and depression in diabetes control

Background: While research shows that depression and diabetes empowerment are each associated with glycemic control among persons with diabetes, the interaction between these two constructs remains unknown. In this study we explored the relationship between depression and diabetes empowerment on glycemic control. Methods: Patients with diabetes (N =289) were recruited from a large Midwestern health system. The sample size was balanced equally by race (African American and white) and gender. The majority of the participants were insured by a single managed care plan. Participants completed the Patient Health Questionnaire (PHQ) to measure depressive symptoms and the Diabetes Empowerment Scale (DES) to measure diabetes-related empowerment. A blood sample was taken to measure glycosylated hemoglobin (HbA1c) as an indicator of glycemic control. ANOVA was used to examine whether depression and diabetes empowerment have an additive or multiplicative effect on glycemic control (i.e., HbA1c). Results: A significant association between depression and diabetes empowerment (p < 0.0001) was observed. When examining PHQ (< 10 vs. ≥ 10) and DES simultaneously, DES was found to be independently associated with HbA1c (p = 0.013) while PHQ was not (p = 0.442). No significant interaction between depression and DES was found on HbA1c (p = 0.540). Conclusions: When depression and diabetes empowerment are considered simultaneously, only diabetes empowerment is found to be associated with HbA1c. These findings suggest that for patients with diabetes who are found to have low diabetes empowerment, interventions focusing on increasing this construct may be helpful in improving their glycemic control.