Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 21 2 2026 03 18 192 201 Zahra Heidari Archandani Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran. Isaac Rahimian-Boogar Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran. 2025 10 25 2026 02 18 Objective: Psychological and behavioral factors play a critical role in diabetes management. This study investigates the structural relationships among the informational-motivational-behavioral skills (IMB) and acceptance and commitment processes with self-management, treatment adherence, and Glycated hemoglobin (HbA1c) levels in diabetic patients, with distress as a mediator. Method: A cross-sectional study was conducted with 321 patients with type 2 diabetes patients referred to health centers in Jiroft, Iran. Data were collected using the Diabetes Self-Management Questionnaire-Revised (DSMQ-R), the IMB-based Diabetic Self-Management Scale (IMB-DSMS), the Diabetes Distress Scale (DDS-17), the Diabetes Acceptance and Action Scale-Revised (DAAS-R), and the Diabetes Mellitus Treatment Adherence Scale (DMTAS). Structural equation modeling (SEM) was employed using LISREL-8.8 for analysis. Results: Acceptance and commitment were positively associated with IMB skills (β = 0.34, P < 0.001), self-management (β = 0.51, P < 0.001), and treatment adherence (t = 8.19, β = 0.55), while negatively associated with distress (β = -0.24, P < 0.001). IMB skills were associated with increased self-management (β = 0.43, P < 0.001) and adherence (β = 0.46, P < 0.001), and also negatively associated with distress (β = -0.40, P < 0.001). Distress was also negatively associated with self-management (β = -0.22, P < 0.001) and adherence (β = -0.29, P < 0.001), and positively associated with HbA1c levels (β = 0.19, P < 0.001). Bootstrap results confirmed distress as a mediator between IMB skills, acceptance, and commitment, and self-management/adherence (P < 0.05). The model showed excellent fit (RMSEA = 0.046, χ²/df = 2.51). Conclusion: This cross-sectional study tested a structural model integrating acceptance-commitment and IMB frameworks. Findings highlight associations among psychological flexibility, IMB skills, reduced distress, and improved self-management. These relationships inform potential intervention targets. Longitudinal and experimental studies are required to evaluate causal effects and clinical implementation. https://ijps.tums.ac.ir/index.php/ijps/article/view/4447 https://ijps.tums.ac.ir/index.php/ijps/article/download/4447/1334