While stressful life events have been shown to be associated with medication nonadherence 15 and A1C, 16 daily activity participation is a relatively novel construct in diabetes research, and its relationship with health and well-being in this population is largely unknown.
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To examine how life experiences affect diabetes management, both stressful life events as well as participation in daily life activities were examined. 12– 14 Perhaps less well-understood are the impact of experiential constructs on diabetes management. 10, 11 The impact of cognitive factors on A1C, including self-efficacy, problem-solving, and diabetes-related knowledge, are also well-known. 7 A broad range of affective factors have also been shown to be related to A1C among individuals with both Type 1 and Type 2 diabetes, including diabetes-specific emotional distress 8, 9 and depressive symptoms. 4, 5 Self-monitoring of blood glucose (SMBG) is strongly associated with reduced A1C in Type 1 diabetes, 6 as well as in Type 2 diabetes when paired with timely and appropriate feedback. In terms of health behaviors, medication adherence is consistently associated with lower A1C in both Type 1 and Type 2 diabetes. For the purpose of this paper, four broad categories of potential influences on A1C were identified: behavioral (specific actions), affective (moods and emotional states), cognitive (thoughts and mental processes), and experiential (engagement in life situations). A1C is affected by a complex constellation of physiological, behavioral, and psychosocial influences, making diabetes management a complex undertaking. 3 Clinical trials of educational and lifestyle interventions, as well as drug therapies, thus commonly employ A1C as a primary outcome given its sensitivity to change and association with events and conditions that are relevant to individuals with diabetes and their healthcare providers.
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1, 2 As such, maintaining blood glucose levels at near-normal levels is the hallmark of diabetes treatment. Elevated blood glucose, typically measured through A1C, has been definitively linked to development of disabling complications of diabetes.