TY  - JOUR
AU  - Reichert, Matthew
AU  - De La Cruz, Barbara A
AU  - Gardiner, Paula
AU  - Mitchell, Suzanne
PY  - 2025
DA  - 2025/2/6
TI  - Diabetes Medical Group Visits and Type 2 Diabetes Outcomes: Mediation Analysis of Diabetes Distress
JO  - JMIR Diabetes
SP  - e57526
VL  - 10
KW  - diabetes
KW  - diabetic
KW  - diabetes mellitus
KW  - DM
KW  - type 1 diabetes
KW  - type 2 diabetes
KW  - diabetes mellitus type 2
KW  - diabetes outcomes
KW  - diabetes medical group visit
KW  - DMGVs
KW  - psychosocial functioning
KW  - psychosocial
KW  - glycemic control
KW  - glycemic
KW  - shared medical appointments
KW  - self-management
KW  - mediation analysis
KW  - social support
KW  - minority women
KW  - minority
AB  - Background: Group-based diabetes care, both technology-enabled and in-person, can improve diabetes outcomes in low-income minority women, but the mechanism remains unclear. Objective: We tested whether diabetes group medical visits (GMVs) reduced hemoglobin A1c (HbA1c) by mitigating diabetes distress (DD), an emotional response affecting nearly half of adults with type 2 diabetes in community settings. Methods: We conducted a mediation and moderation analysis of data from the Women in Control 2.0 comparative effectiveness study, which showed that both technology-enabled and in-person diabetes GMVs improve HbA1c. We tested whether DD mediated the relationship between diabetes GMV engagement and reductions in HbA1c. We also tested whether this relationship was moderated by depressive symptoms and social support. Participants were 309 low-income and minority women. Diabetes GMV engagement was measured using the Group Climate Questionnaire. The mediator, DD, was measured using the Diabetes Distress Screening Scale. The outcome was the 6-month change in HbA1c. Social support was measured using the Medical Outcomes Study Social Support Survey. Results: DD mediated the relationship between engagement and 6-month HbA1c. Specifically, group engagement affected HbA1c by reducing distress associated with the regimen of diabetes self-management (P=.04), and possibly the emotional burden of diabetes (P=.09). The relationship between engagement and 6-month HbA1c was moderated by depressive symptoms (P=.02), and possibly social support (P=.08). Conclusions: Engagement in diabetes GMVs improved HbA1c because it helped reduce diabetes-related distress, especially related to the regimen of diabetes management and possibly related to its emotional burden, and especially for women without depressive symptoms and possibly for women who lacked social support. Trial Registration: ClinicalTrials.gov NCT02726425; https://clinicaltrials.gov/study/NCT02726425 
SN  - 2371-4379
UR  - https://diabetes.jmir.org/2025/1/e57526
UR  - https://doi.org/10.2196/57526
DO  - 10.2196/57526
ID  - info:doi/10.2196/57526
ER  -