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Prospective Study on Influence of Psychosocial Factors on Glycemic Control in Japanese Patients With Type 2 Diabetes

Received January 18, 2005; revised June 30, 2005; accepted August 9, 2005. From the Dept. of Psychosomatic Medicine, Faculty of Medicine, The Univ. of Tokyo, Tokyo, Japan; the Dept. of Psychiatry, Teikyo Univ. Mizonokuchi Hospital, Kanagawa, Japan; the Institute for Diabetes Care and Research, Asahi Life Foundation, Tokyo; and the Kawamura Gakuen Woman's University, Chiba, Japan. Send correspondence and reprint requests to Dr. Nakahara, Dept. of Psychosomatic Medicine, Faculty of Medicine, the Univ. of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. e-mail: nrika-tky{at}umin.ac.jp

The authors prospectively assessed the causal relationship between psychosocial factors and glycemic control in 256 Japanese outpatients with Type 2 diabetes. Using structural-equation modeling, they first developed a causal model in which glycosylated hemoglobin (HbA_1c) at 6 months after assessment was influenced by the baseline psychosocial factors. Then, the reliability of the causal model was investigated with measurement of HbA_1c at 12 months after baseline. Self-efficacy directly reinforced adherence, and adherence had a direct association with future HbA_1c. Other psychosocial factors, including social support, diabetes-related distress, daily burden, and emotion-focused coping prospectively influenced HbA_1c indirectly through self-efficacy.

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