Pathways to Glycemic Control: Diabetes Distress as a Mediator of the Impact of the EPICC Intervention in Veterans with Type 2 Diabetes

Empowering Patients in Chronic Care (EPICC) is a patient-centered intervention that leverages a group-based approach, collaborative goal-setting, and motivational interviewing techniques to improve diabetes outcomes. However, the process by which EPICC’s collaborative goal-setting results in improved diabetes outcomes differs from traditional self-management and may be related to emotion regulation rather than disease centric goals. This study examines the role of diabetes distress in reduction of HbA1c following the EPICC intervention. A cohort of 224 participants with treated but uncontrolled type 2 diabetes were randomized to receive either EPICC or enhanced usual care (EUC). Examination of direct and indirect effects of the relationship between treatment group and improvements in HbA1c revealed that relative to EUC, Veterans in the EPICC group had lower HbA1c post-intervention indirectly through reduction in diabetes distress. These findings underscore the role of psychosocial well-being in diabetes management.