Hemoglobin A1c improvements and better diabetes-specific quality of life among participants completing diabetes self-management programs: A nested cohort study

Background: Numerous primary care innovations emphasize patient-centered processes of care. Within the context of these innovations, greater understanding is needed of the relationship between improvements in clinical endpoints and patient-centered outcomes. To address this gap, we evaluated the association between glycosylated hemoglobin (HbA(1c)) and diabetes-specific quality of life among patients completing diabetes self-management programs. Methods: We conducted a retrospective cohort study nested within a randomized comparative effectiveness trial of diabetes self-management interventions in 75 diabetic patients. Multiple linear regression models were developed to examine the relationship between change in HbA(1c) from baseline to one-year follow-up and Diabetes-39 (a diabetes-specific quality of life measure) at one year. Results: HbA(1c) levels improved for the overall cohort from baseline to one-year follow-up (t (74) = 3.09, p =.0029). One-year follow up HbA(1c) was correlated with worse overall quality of life (r = 0.33, p = 0.004). Improvements in HbA(1c) from baseline to one-year follow-up were associated with greater D-39 diabetes control (beta = 0.23, p = .04) and D-39 sexual functioning (beta = 0.25, p = .03) quality of life subscales. Conclusions: Improvements in HbA(1c) among participants completing a diabetes self-management program were associated with better diabetes-specific quality of life. Innovations in primary care that engage patients in self-management and improve clinical biomarkers, such as HbA(1c), may also be associated with better quality of life, a key outcome from the patient perspective.