Pathways for the relationship between diabetes distress, depression, fatalism and glycemic control in adults with type 2 diabetes

Background The aim of this study was to examine the mechanism by which depressive symptoms, diabetes distress, and diabetes fatalism together influence diabetes outcomes using structured equation modeling. Methods 615 adults with type 2 diabetes were recruited from two primary care clinics in the southeastern United States. Psychosocial factors found to be associated with diabetes outcomes were measured using validated questionnaires. Structured equation modeling (SEM) was used to investigate the relationship between diabetes fatalism, depressive symptoms, diabetes distress, self-care and glycemic control. Results The final model (chi²(903) = 24,088.91, p < 0.0001, R² = 0.93, RMSEA = 0.05 and CFI = 0.90) showed that higher diabetes distress was directly significantly related to a decreased self-care (r = − 0.69, p < 0.001) and increased HbA1c (r = 0.69, p < 0.001). There was no significant direct association between depressive symptoms or fatalism, and glycemic control or self-care. There was, however, an indirect association between increased depressive symptoms and increased fatalism, explained through the direct association with diabetes distress in that higher depressive symptoms (0.76, p < 0.001) and higher fatalism (0.11, p < 0.001) were significantly associated with higher diabetes distress. Conclusion Diabetes distress serves as a pathway through which depressive symptoms and fatalism impact both glycemic control and self-care. In addition, pathways between diabetes distress and both self-care behaviors and glycemic control in patients with type 2 diabetes remained separate, suggesting the need to address both psychological and behavioral factors in standard diabetes care, rather than focusing on psychological care primarily through support for self-management and treatment of depression.