Relationships between dispositional mindfulness, health behaviors, and hemoglobin A1c among adults with type 2 diabetes.

Examine cross-sectional relationships between dispositional mindfulness and diabetes self-care behaviors (i.e., medication adherence, diet and exercise behavior, and self-monitoring of blood glucose; SMBG), hemoglobin A1c (HbA1c, %), and body mass index (BMI; continuously and obese vs. not). Adults with type 2 diabetes (N = 148, Mage = 55.7 ± 10.1) who were recruited to participate in a web-based diabetes medication adherence intervention completed all assessments at enrollment. In unadjusted analyses, mindfulness was associated with better dietary habits and worse HbA1c (p < .05). After controlling for a priori covariates (demographics, years since diabetes diagnosis, and insulin status), mindfulness remained associated with better dietary behavior (p < .01) but not HbA1c. Mindfulness was not associated with medication adherence, exercise behavior, SMBG, or body mass index. We found evidence that dispositional mindfulness plays an important role in dietary behaviors, supporting the use of mindful eating techniques in diabetes self-management interventions. Fostering mindfulness may be one of several behavioral tools needed to support key self-care behaviors and improve HbA1c.

Medication adherence may be more important than other behaviours for optimizing glycaemic control among low-income adults.

WHAT IS KNOWN: Patients with type 2 diabetes mellitus (T2DM) are required to perform multiple self-care behaviours to achieve and maintain optimal glycaemic control (HbA1c), which prevents complications and premature mortality. Patients with T2DM and low socioeconomic status (SES) are more likely to have suboptimal HbA1c, often due to being less adherent to recommended self-care activities than their higher-SES counterparts. OBJECTIVE: Although studies support performing certain diabetes self-care behaviours for optimizing glycaemic control, there is limited research on the relative importance of each behaviour for this purpose. Identifying what behaviours are most important for HbA1c among low-SES patients with T2DM would be particularly useful for informing policy and intervention efforts for this high-risk group. METHODS: In a cross-sectional study of 314 adults with T2DM and low SES, we used the Summary of Diabetes Self-Care Activities to assess self-care behaviours and multivariate models to test which behaviours were associated with lower HbA1c. RESULTS AND DISCUSSION: Only medication adherence was significantly associated with lower HbA1c after adjusting for the other self-care behaviours (ß = -0·14, P = 0·028) and further adjusting for demographic and diabetes characteristics (ß = -0·16, P = 0·024). WHAT IS NEW: Medication adherence may be the most important self-care behaviour for glycaemic control among adults with T2DM and low SES. CONCLUSION: Focused efforts to improve medication adherence among low-SES patient populations may improve glycaemic control.