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We examined emotional distress in relation to metformin adherence, overall diabetes self-management, and glycemic control among adults with early type 2 diabetes (T2DM) enrolled in the GRADE study.Linear regression models examined cross-sectional associations of baseline depression symptoms and diabetes distress with adherence to metformin, self-management, and HbA1c, adjusting for covariates. Cognitive-affective (e.g., sadness) and somatic (e.g., sleep/appetite disturbance) depression symptoms and diabetes distress subscales were also examined.This substudy of 1,739 GRADE participants (56% Non-Hispanic White, 18% Non-Hispanic Black, 17% Hispanic, 68% male, mean[SD] age=57.96[10.22] years, diabetes duration=4.21[2.81] years, and HbA1c=7.51[0.48]). The prevalence of clinically significant depression and diabetes distress was 8.7% and 25%, respectively. Fully adjusted models showed that depression symptoms were associated with lower self-management (p0.0001); this effect was only significant for somatic symptoms. Diabetes distress was associated with lower adherence (p=0.0001) and self-management (p0.0001); effects were significant for all subscales, except physician-related distress. No significant relationships of total depression symptom severity or diabetes distress with HbA1c were found.Depression symptoms and diabetes distress were robustly associated with problematic diabetes self-management among participants in GRADE. These findings highlight the need for routine assessment of depression symptoms and diabetes distress early in T2DM care.

Background: Little is known about continued high-risk sexual behavior of persons living with HIV disease in rural areas of the United States. However, as HIV seroprevalence rates increase in rural communities, there is an urgent need to develop interventions to assist HIV-infected rural individuals who have difficulty refraining from high-risk sex. Goal: To characterize patterns of continued high-risk sex among 216 men and women living with HIV disease in rural areas of 12 states. Study Design: Cross-sectional, self-administered survey. Results: Thirty-two percent of men and 38% of women reported that all of their sex partners in the previous 3 months were HIV-seronegative. Among the 33% of men who engaged in anal sex, 59% never or rarely used condoms. Of the 55% of women who engaged in vaginal sex in the previous 3 months, 31% never used condoms. Conclusion: Culturally contextualized interventions are needed to initiate and facilitate the risk-reduction efforts of HIV-infected rural persons.