| Type 2 diabetes is a devastating chronic illness with far reaching emotional and physical consequences. The illness can be controlled with proper self-management, yet two-thirds of those diagnosed with type 2 diabetes have poor control. Path analysis was used to evaluate the relationships between three illness cognitions, (helplessness, perceived benefit, and acceptance), three self-management behaviors (diet, exercise, and sugar checks (SMBG), and hemoglobin A1c (HbA1c). The population studied included 109 non-depressed type 2 diabetics. The illness cognitions were predicted to influence the extent to which patients engage in self-management behaviors. Helplessness was significantly related only to exercise -.21 p<.05; Perceived benefit was not significantly related to any of the self-management behaviors, and Acceptance was significantly related to diet .31 p<.01 and SMBG .35 p<.01, but it was not significantly related to exercise. The self-management behaviors in turn were predicted to fully mediate the relationship between illness cognitions and HbA1c. Three models in which each of the self-management behaviors served as a mediator between the illness cognitions and HbA1c were run. In each case the relationship between the self-management behavior and HbA1c was not significant, and full mediation was not supported. The three illness cognitions and the self-management behaviors of diet, exercise and SMBG explained 2%, 0%, and 1 % of the variance in HbA1c respectively. A respecified model with a direct path from acceptance to HbA1c was evaluated. This model proved to be a better fit, with the path from acceptance to HbA1c significant .28 p<.01; and the variance explained in HbA1c rising to 8%. Results of this study imply that acceptance; in addition to influencing self management behaviors may confer a direct physiological effect on HbA1c. The physiological stress response is discussed as a possible avenue for this effect. |
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