1. Abstract Background While research shows that depression and diabetes empowerment are each associated with glycemic control among persons with diabetes, the interaction between these two constructs remains unknown. In this study we explored the relationship between depression and diabetes empowerment and their influence on glycemic control. Methods Patients with diabetes (N = 289) were recruited from a large Midwestern health system. The sample size was balanced equally by race (African American and white) and gender. The majority of participants were insured by a single managed care plan. Participants completed the Patient Health Questionnaire (PHQ) to measure depressive symptoms and the Diabetes Empowerment Scale (DES) to measure diabetes-related empowerment. A blood sample was taken to measure glycosylated hemoglobin (HbA1c) as an indicator of glycemic control. ANOVA was used to examine whether depression and diabetes empowerment have an additive or multiplicative effect on glycemic control (i.e., HbA1c). Results A significant association between depression and diabetes empowerment scores (p < 0.0001) was observed. When examining PHQ (< 10 vs. ≥ 10) and DES simultaneously, DES was found to be independently associated with HbA1c (p = 0.013) while PHQ was not (p = 0.442). No significant interaction between depression and DES was found on HbA1c (p = 0.540). Conclusions When depression and diabetes empowerment are considered simultaneously, only diabetes empowerment is found to be associated with HbA1c. These findings suggest that for patients with diabetes who are found to have low diabetes empowerment, interventions focusing on increasing this construct may be helpful in improving their glycemic control. Background Glycemic control is a challenge for many people with diabetes and can be even more difficult for those with co-morbid depression. Studies have shown that individuals with both diabetes and depression are less likely to have HbA1c in the normal range 1 Diabetes empowerment, or diabetes-related psychosocial self-efficacy, has been shown to be associated with diabetes control 2,3 Since both diabetes empowerment and depression have been shown to be associated with glycemic control, we were interested in the combined effect of both factors on this outcome References 1.Lustman, P. J., Anderson, R. J., Freedland, K. E., de Groot, M., Carney, R. M., & Clouse, R. E. (2000). Depression and poor glycemic control: A meta-analytic review of the literature. Diabetes Care. 23(7):934-42. 2.Anderson, R. M., Funnell, M. M., Butler, P. M., Arnold, M. S., Fitzgerald, J. T., & Feste, C. C. (1995). Patient empowerment: Results from a randomized controlled trial. Diabetes Care. 18(7):943-9. 3.Krichbaum, K., Aarestad, V., & Buethe, M. (2003). Exploring the connections between self-efficacy and effective diabetes self-management. Diabetes Educ. 29(4):653-62. 4.Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 16:606-13. 5.Funnell, M. M., & Anderson, R. M. (2004). Empowerment and self-management of diabetes. Clinical Diabetes. 22(3):123-127. 6.Anderson, R. M., Fitzgerald, J. T., Gruppen, L. D., Funnell, M. M., & Oh, M. S. (2003). The Diabetes Empowerment Scale - Short Form. Diabetes Care. 26(5):1641-2. Methods The PHQ-9 is the 9-item depression module from the full Patient Health Questionnaire. It is self-administered and the results are used to diagnose depression symptoms and disorders. Patients with a score of 10 or more are considered to have moderate depression with those having a score of 15 or higher as having moderately severe depression 4 Patient empowerment is defined as helping patients discover and develop the inherent capacity to be responsible for one’s own life. 5 The Diabetes Empowerment Scale-Short Form measures overall diabetes-related psychosocial self-efficacy using an 8-items self-administered scale 6 Glycemic control was measured using participants’ baseline HbA1c The association between depression (PHQ-9 scores) and diabetes empowerment (DES-SF scores ) was tested using two-sample t-test A two-way Analysis of Variance (ANOVA) model was fit to test the effect of PHQ-9 and DES-SF on baseline Hba1c values The interaction between PHQ-9 and DES-SF also was tested at p < 0.10 Assessing the roles of diabetes empowerment and depression in diabetes control M. L. Brady, MPH, MSW, D. White Perkins, MD, PhD, S. Milberger, ScD, D. Saffar, MPH, A. Kapke, MS, V. Williams, MPH, J. E. Aikens, PhD Institute on Multicultural Health, Henry Ford Hospital, Detroit, Michigan Results 3.13 (0.569)59 ≥10 <0.00013.68 (0.683)224<10 p-value Mean DES score (SD) NPHQ-9 Table 1. Association between DES-SF score and PHQ-9 score 0.01316.31-0.386DES-SF 0.44210.590.202PHQ-9 p-valueDFF Value Beta Estimate Table 2. ANOVA Model for HbA1c, PHQ-9, and DES-SF Table 3. Interaction between DES and Depression on HbA1c 0.53970.381DES-SF x PHQ-9 0.02644.981DES-SF 0.45530.561PHQ-9 p-valueF ValueDF Key Findings In this sample, those who had a PHQ ≥ 10 scored significantly lower on the Diabetes Empowerment Survey compared to those with a PHQ < 10 PHQ (< 10 vs. ≥ 10) was not significantly associated with HbA1c among this sample; however, the average DES score was When looking at the interaction of PHQ and DES, there is no significant effect on HbA1c at p < 0.10 Conclusions Among study participants, those who scored 10 or higher on the PHQ-9 had significantly lower scores on the DES-SF. This finding suggests that those individuals who show signs of depression may have less diabetes-related psychosocial self-efficacy Diabetes empowerment, as measured by the DES-SF, was significantly associated with glycemic control (HbA1c) while depression, as measured by the PHQ-9, was not Depression score and diabetes empowerment did not have a significant additive or multiplicative effect on HbA1c Diabetes empowerment may be an important factor to consider when working with patients to help them control their diabetes, and program and interventions that seek to increase patients’ empowerment to control their diabetes should be considered Results (continued)