Purpose The purpose of this study was to examine whether baseline levels of diabetes distress (DD) impacted clinical benefit from a mobile health (mHealth) diabetes self-management education and support (DSME/S) intervention (“Dulce Digital”). Methods This secondary analysis included the full sample of 126 Hispanic adults (mean age = 48.43 years, SD = 9.80) with type 2 diabetes and glycosylated hemoglobin A1C >7.5% enrolled from a Federally Qualified Health Center in a randomized, nonblinded clinical trial that compared Dulce Digital to usual care. Dulce Digital participants received educational/motivational, medication reminders, and blood glucose monitoring prompt text messages over 6 months. Results Baseline levels of DD prospectively moderated the effect of Dulce Digital (vs usual care) on glycemic control over 6 months, such that Dulce Digital participants with higher DD experienced relatively greater benefit from the intervention. The effect of the intervention on A1C change was 178% larger among individuals experiencing moderate/high versus no/low DD. Conclusions Although research has found DD to be associated with poorer self-management and clinical outcomes, individuals already distressed about their diabetes may benefit from a lower-burden mHealth DSME/S approach.

中文翻译：

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糖尿病困扰是否会影响对移动医疗糖尿病自我管理教育和支持干预的临床反应？

目的 本研究的目的是检查糖尿病困扰 (DD) 的基线水平是否会影响移动健康 (mHealth) 糖尿病自我管理教育和支持 (DSME/S) 干预（“Dulce Digital”）的临床获益。方法 这项二次分析包括 126 名患有 2 型糖尿病且糖化血红蛋白 A1C > 7.5% 的西班牙裔成年人（平均年龄 = 48.43 岁，SD = 9.80）的完整样本，他们从联邦合格的健康中心参加一项随机、非盲临床试验，比较Dulce Digital 进行日常护理。Dulce Digital 参与者在 6 个月内收到了教育/激励、药物提醒和血糖监测提示短信。结果 DD 的基线水平前瞻性地调节了 Dulce Digital（与常规护理相比）对 6 个月内血糖控制的影响，因此，具有较高 DD 的 Dulce Digital 参与者从干预中获得了相对更大的收益。在经历中度/高 DD 与无/低 DD 的个体中，干预对 A1C 变化的影响要大 178%。结论 尽管研究发现 DD 与较差的自我管理和临床结果相关，但已经对糖尿病感到苦恼的个人可能会受益于负担较低的 mHealth DSME/S 方法。