Abstract
OBJECTIVE: 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. RESEARCH DESIGN AND METHODS: 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 A(1c) (HbA(1c)) 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 HbA(1c) over the 12 months after the survey, controlling for mean prior 12-month HbA(1c), time, insulin use, age, and race/ethnicity. RESULTS: 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 HbA(1c) levels. Autonomy support moderated the relationship between diabetes distress and HbA(1c) (B = -0.13 [SE 0.06]; P = 0.027). Greater diabetes distress was associated with higher HbA(1c) 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. CONCLUSIONS: 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.