Diabetes Distress and Glycemic Control: The Buffering Effect of Autonomy Support From Important Family Members and Friends


To examine whether autonomy support (defined as social support for an individual’s personal agency) for diabetes management from informal health supporters (family/friends) reduces the detrimental effects of diabetes distress on glycemic control.


Three hundred eight veterans with type 2 diabetes and one or more risk factors for diabetes complications completed a survey that included measures of diabetes distress and perceived autonomy support from their main informal health supporter. Hemoglobin A1c (HbA1c) data from 12 months before and after the survey were extracted from electronic medical records. Linear mixed modeling examined the main effects and interaction of autonomy support and diabetes distress on repeated measures of HbA1c over the 12 months after the survey, controlling for mean prior 12-month HbA1c, time, insulin use, age, and race/ethnicity.


Diabetes distress (B = 0.12 [SE 0.05]; P = 0.023) was associated with higher and autonomy support (B = –0.16 [SE 0.07]; P = 0.032) with lower subsequent HbA1c levels. Autonomy support moderated the relationship between diabetes distress and HbA1c (B = –0.13 [SE 0.06]; P = 0.027). Greater diabetes distress was associated with higher HbA1c at low (B = 0.21 [SE 07]; P = 0.002) but not high (B = 0.01 [SE 0.07]; P = 0.890) levels of autonomy support.


Autonomy support from main health supporters may contribute to better glycemic control by ameliorating the effects of diabetes distress. Interventions that reduce diabetes distress and enhance the autonomy supportiveness of informal supporters may be effective approaches to improving glycemic control.

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