The associations between psychosocial and physiological factors and diabetes’ health indicators have not been widely investigated among Asians and Pacific Islanders. We hypothesize that health behaviour and depression are directly or indirectly associated with diabetes’ health indicators such as BMI, glycemic control, general health, and diabetes quality of life. Our hypothesis was tested through a structural equation modelling (SEM) approach. Questionnaires that assessed health behaviour, depression, general health, diabetes quality of life, and haemoglobin A1c (HbA1c), along with patients’ demographic information, were obtained from 207 Asian and Pacific Islander adults with type 2 diabetes. IBM SPSS Amos 20 was used for the SEM analysis at 5% level of significance, and the goodness fit of the SEM model was also evaluated. The final SEM model showed that diet and exercise and foot care had positive associations, while depression had a negative association with diabetes’ health indicators. The results highlighted the importance of exercise and depression in diabetes patients’ BMI, glycemic control, general health, and quality of life, which provide evidence for the need to alleviate patients’ depression besides education and training in diet and exercise in future intervention studies among Asians and Pacific Islanders with type 2 diabetes. 1. Introduction Diabetes is a chronic disease that affects about 11.3% of all people aged 20 years and older in the USA [1] and a growing epidemic within ethnic minority populations including Pacific Islanders and Asian Americans [2]. Health behaviours such as diet, exercise, and depression contribute to diabetes’ health indicators such as BMI, glycemic control, quality of life, and general well-being. Previous studies demonstrated the direct association between health behavior and glycemic control [3–6]. A current study also found that physical exercise can control, prevent, or delay the onset of type 2 diabetes by markedly improving the low insulin sensitivity in at-risk patients [7]. A recent intervention programme conducted in Australia revealed the negative association between exercise and depression [8]. They found that overweight participants with heart disease and diabetes were less likely to report depressive symptoms after adjusting for treatment group and weight change, if they met recommendations for total duration of exercise. An important relationship between depressive symptoms and a heightened metabolic risk for type 2 diabetes, including prediabetes and impairment of β-cell function relative to
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