Doctor of Philosophy
Social and Behavioral Health
People with type 1 diabetes must perform frequent self-management behaviors to maintain glycemic control. Those with higher diabetes distress tend to have worse glycemic control, indicated by higher A1C. Financial stress is common in adults with chronic diseases, but little is known about perceived financial burden in adults with type 1 diabetes or its associations with diabetes distress, self-management behaviors, or A1C. It is also unknown whether diabetes self-efficacy moderates the associations between perceived financial burden or diabetes distress with self-management behaviors.
Surveys were collected from 235 adults with type 1 diabetes. Structural equation modeling tested whether perceived financial burden and diabetes distress were associated with self-management behaviors and A1C; whether performance of self-management behaviors mediated associations between perceived financial burden and diabetes distress with A1C; and whether diabetes self-efficacy moderated associations of perceived financial burden and diabetes distress with self-management behaviors. Education, age, and race/ethnicity were included as covariates. Exploratory analyses assessed correlates of perceived financial burden.
Higher diabetes distress was associated with higher perceived financial burden (β=0.34, p<0.001) and less frequent self-management behaviors (β= -0.74, p<0.001). Lower A1C was associated with more frequent self-management behaviors (β= -0.22, p=0.050) and higher educational attainment (β= -0.20, p=0.02). Direct effects of diabetes distress and perceived financial burden on A1C were not significant, nor were indirect effects mediated by self-management behaviors. Diabetes self-efficacy did not moderate associations of perceived financial burden or diabetes distress with self-management behaviors. Higher perceived financial burden was associated with lower income (p<0.001), lower general quality of life (r=-0.19, p=0.003), and more chronic complications (r=0.19, p<0.01). Perceived financial burden was highest in uninsured participants (p=0.01); Among insured, those with lower perceived adequacy of insurance reported higher perceived financial burden (p<0.001).
Findings suggest those with higher diabetes distress perform fewer self-management behaviors. Higher perceived financial burden was associated with higher diabetes distress, but its associations with self-management behaviors and A1C were not significant. Longitudinal research is needed in larger samples of adults with type 1 diabetes to explore relations among diabetes distress, perceived financial burden, self-management behaviors, and A1C, as well as identify characteristics that mitigate sources of stress.
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