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The purpose of this cross-sectional study was to explore the determinants of hemoglobin A1c (HbA1c) levels in insulin-treated patients with Type 2 diabetes mellitus (T2DM) based on demographic and disease characteristics, self-reported regimen adherence factors (adherence in insulin regimen and self-monitoring of blood glucose), and psychosocial factors (decisional balance for insulin injection, health literacy, self-efficacy for insulin injection, diabetes distress, and empowerment perceptions). Via convenience sampling, 255 insulin-treated patients with T2DM were recruited from two endocrinology clinics in Taiwan. A self-report questionnaire was used to collect demographic and disease characteristics, regimen adherence factors, and psychosocial factors. The first HbA1c level measured after completion of the questionnaire was the dependent variable. The last HbA1c level measured before patients started insulin therapy as well as body mass index (BMI) was collected from medical records. Results indicated that adherence in insulin regimen was relatively good. Regimen adherence factors did not significantly correlate with HbA1c levels, but empowerment perception, decisional balance for insulin injection, health literacy, and diabetes distress did. The hierarchical multiple regression models indicated that BMI, the last HbA1c levels before starting insulin therapy, empowerment perception, and diabetes distress were important determinants of HbA1c levels. Nurses could periodically assess the diabetes distress of insulin-treated patients with T2DM and refer to mental health professionals when needed. Furthermore, applying empowerment approaches such as enhancing self-awareness of improved glycemic control and sharing more decision-making power with insulin-treated patients with T2DM might have benefits for their glycemic control. [ABSTRACT FROM AUTHOR]

Purposes: Women with diabetes (WD) are more severely impacted by the consequence of suboptimal diabetes control. This study aims to examine the impact of demographic and disease characteristics, baseline self-stigma, role strain, diabetes distress on Hemoglobin A1C (A1C) levels, quality of life (D-QoL) and 6-month A1C levels in younger WD. Methods: This study was a 6-month prospective study. In total, 193 WD aged 20–64 years were selected by convenience sampling from three outpatient clinics in Taiwan. Demographic and disease characteristics, self-stigma, role strain, diabetes distress, A1C levels, and D-QoL were collected at baseline. A1C levels were further collected 6 months later. Structural equation modeling was conducted to test the hypothesized model. Results: The final model supported that higher baseline D-QoL directly associated with lower concurrent A1C levels and indirectly associated with lower 6-month A1C levels through baseline A1C levels. Higher baseline self-stigma, role strain, and diabetes distress directly associated with lower baseline D-QoL, and indirectly associated with higher 6-month A1C levels through D-QoL. Conclusion: Improving self-stigma, role strain, and diabetes distress should be considered as promising strategies to improve D-QoL in young WD. D-QoL plays a mediation role between baseline self-stigma, role strain, diabetes distress and subsequent glycemic control in younger WD. Enhancing baseline D-QoL is fundamental to improve subsequent glycemic control. [ABSTRACT FROM AUTHOR]