{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:44:12Z","timestamp":1787507052022,"version":"build-2736575974"},"reference-count":41,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Diabetes"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Group-based diabetes care, both technology-enabled and in-person, can improve diabetes outcomes in low-income minority women, but the mechanism remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n We tested whether diabetes group medical visits (GMVs) reduced hemoglobin A\n 1c<\/jats:sub>\n (HbA\n 1c<\/jats:sub>\n ) by mitigating diabetes distress (DD), an emotional response affecting nearly half of adults with type 2 diabetes in community settings.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We conducted a mediation and moderation analysis of data from the Women in Control 2.0 comparative effectiveness study, which showed that both technology-enabled and in-person diabetes GMVs improve HbA\n 1c<\/jats:sub>\n . We tested whether DD mediated the relationship between diabetes GMV engagement and reductions in HbA\n 1c<\/jats:sub>\n . We also tested whether this relationship was moderated by depressive symptoms and social support. Participants were 309 low-income and minority women. Diabetes GMV engagement was measured using the Group Climate Questionnaire. The mediator, DD, was measured using the Diabetes Distress Screening Scale. The outcome was the 6-month change in HbA\n 1c<\/jats:sub>\n . Social support was measured using the Medical Outcomes Study Social Support Survey.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n DD mediated the relationship between engagement and 6-month HbA\n 1c<\/jats:sub>\n . Specifically, group engagement affected HbA\n 1c<\/jats:sub>\n by reducing distress associated with the regimen of diabetes self-management (\n P<\/jats:italic>\n =.04), and possibly the emotional burden of diabetes (\n P<\/jats:italic>\n =.09). The relationship between engagement and 6-month HbA\n 1c<\/jats:sub>\n was moderated by depressive symptoms (\n P<\/jats:italic>\n =.02), and possibly social support (\n P<\/jats:italic>\n =.08).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Engagement in diabetes GMVs improved HbA\n 1c<\/jats:sub>\n because it helped reduce diabetes-related distress, especially related to the regimen of diabetes management and possibly related to its emotional burden, and especially for women without depressive symptoms and possibly for women who lacked social support.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/57526","type":"journal-article","created":{"date-parts":[[2024,12,9]],"date-time":"2024-12-09T15:23:01Z","timestamp":1733757781000},"page":"e57526-e57526","source":"Crossref","is-referenced-by-count":2,"title":["Diabetes Medical Group Visits and Type 2 Diabetes Outcomes: Mediation Analysis of Diabetes Distress"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7666-9200","authenticated-orcid":false,"given":"Matthew","family":"Reichert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0012-8413","authenticated-orcid":false,"given":"Barbara A","family":"De La Cruz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3663-000X","authenticated-orcid":false,"given":"Paula","family":"Gardiner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5618-7383","authenticated-orcid":false,"given":"Suzanne","family":"Mitchell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,2,6]]},"reference":[{"key":"R1","unstructured":"National diabetes statistics report. 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