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Socioeconomic status and glycemic control in adult patients with type 2 diabetes: a mediation analysis
  1. Janie Houle1,2,
  2. François Lauzier-Jobin1,
  3. Marie-Dominique Beaulieu2,3,
  4. Sophie Meunier1,
  5. Simon Coulombe1,
  6. José Côté2,4,
  7. François Lespérance2,5,
  8. Jean-Louis Chiasson2,6,
  9. Louis Bherer7,8,
  10. Jean Lambert9
  1. 1Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
  2. 2CRCHUM, Montréal, Québec, Canada
  3. 3Department of Family and Emergency Medicine, Université de Montréal, Montréal, Québec, Canada
  4. 4Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
  5. 5Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada
  6. 6Department of Medicine, Université de Montréal, Montréal, Québec, Canada
  7. 7PERFORM Centre, Concordia University, Montréal, Québec, Canada
  8. 8Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
  9. 9Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Québec, Canada
  1. Correspondence to Dr Janie Houle; houle.janie{at}


Objective The purpose of this study is to examine the contribution of health behaviors (self-management and coping), quality of care, and individual characteristics (depressive symptoms, self-efficacy, illness representations) as mediators in the relationship between socioeconomic status (SES) and glycemic control.

Methods A sample of 295 adult patients with type 2 diabetes was recruited at the end of a diabetes education course. Glycemic control was evaluated through glycosylated hemoglobin (HbA1c). Living in poverty and education level were used as indicators of SES.

Results Bootstrapping analysis showed that the significant effects of poverty and education level on HbA1c were mediated by avoidance coping and depressive symptoms. The representation that diabetes is unpredictable significantly mediated the relationship between living in poverty and HbA1c, while healthy diet mediated the relationship between education level and HbA1c.

Conclusions To improve glycemic control among patients with low SES, professionals should regularly screen for depression, offering treatment when needed, and pay attention to patients' illness representations and coping strategies for handling stress related to their chronic disease. They should also support patients in improving their self-management skills for a healthy diet.

  • A1C
  • Depression
  • Coping
  • Low Income

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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