Diabetes-related distress and its associated factors among patients with type 2 diabetes mellitus in China

Prevalence and factors associated with diabetes-related distress in type 2 diabetes patients: a study in Hong Kong primary care setting

Diabetes-related distress (DRD) refers to the psychological distress specific to living with diabetes. DRD can lead to negative clinical consequences such as poor self-management. By knowing the local prevalence and severity of DRD, primary care teams can improve the DRD evaluation in our daily practice. This was a cross-sectional study conducted in 3 General Out-patient Clinics (GOPCs) from 1 December 2021 to 31 May 2022. A random sample of adult Chinese subjects with T2DM, who regularly followed up in the selected clinic in the past 12 months, were included. DRD was measured by the validated 15-item Chinese version of the Diabetes Distress Scale (CDDS-15). An overall mean score ≥ 2.0 was considered clinically significant. The association of DRD with selected clinical and personal factors was investigated. The study recruited 362 subjects (mean age 64.2 years old, S.D. 9.5) with a variable duration of living with T2DM (median duration 7.0 years, IQR 10.0). The response rate was 90.6%. The median HbA1c was 6.9% (IQR 0.9). More than half (59.4%) of the subjects reported a clinically significant DRD. Younger subjects were more likely to have DRD (odds ratio of 0.965, 95% CI 0.937-0.994, p = 0.017). Patients with T2DM in GOPCs commonly experience clinically significant DRD, particularly in the younger age group. The primary care clinicians could consider integrating the evaluation of DRD as a part of comprehensive diabetes care.

Simplified integration of optimal self-management behaviors is associated with improved HbA1c in patients with type 1 diabetes

PURPOSE

Living with type 1 diabetes requires burdensome and complex daily diabetes self-management behaviors. This study aimed to determine the association between integrated behavior performance and HbA1c, while identifying the behavior with the most significant impact on HbA1c.

METHODS

A simple and feasible questionnaire was used to collect diabetes self-management behavior in patients with type 1 diabetes (n = 904). We assessed six dimensions of behavior performance: continuous glucose monitor (CGM) usage, frequent glucose testing, insulin pump usage, carbohydrate counting application, adjustment of insulin doses, and usage of apps for diabetes management. We evaluated the association between these behaviors and HbA1c.

RESULTS

In total, 21.3% of patients performed none of the allotted behavior, while 28.5% of patients had a total behavior score of 3 or more. 63.6% of patients with a behavior score ≥ 3 achieved HbA1c goal, contrasting with only 30.4% of patients with a behavior score of 0-1. There was a mean 0.54% ± 0.05% decrease in HbA1c for each 1-unit increase in total behavior score after adjustment for age, family education and diabetes duration. Each behavior was independently correlated with a lower HbA1c level, with CGM having the most significant effect on HbA1c levels.

CONCLUSIONS

Six optimal self-management behaviors, especially CGM usage, were associated with improved glycemic control, emphasizing the feasibility of implementing a simplified version of DSMES in the routine clinical care.

REGISTRATION NUMBER

ClinicalTrials.gov Identifier: NCT03610984.

Diabetes Distress Among Patients Undergoing Surgery for Diabetic Retinopathy and Associated Factors: A Cross-Sectional Survey

Background

Diabetes distress (DD) is a negative emotion related to diabetes management and a predictor of depression; it affects diabetic retinopathy (DR) patients' quality of life and disease outcomes. The prevalence of DD was higher in patients undergoing surgery for DR. However, few studies have been conducted on DD in DR surgery patients. The present study aims to investigate the status of DD in DR surgery patients and identify factors associated with DD.

Methods

Using a convenience sampling method, 210 DR surgery patients who were admitted to 2 tertiary-level hospitals in Wenzhou City (Zhejiang Province) and Zhengzhou City (Henan Province) from February to June 2023 were selected as research subjects. A questionnaire collecting demographic and disease-related information, the Diabetes Distress Scale, the Summary of Diabetes Self-Management Activities, the Family Care Index Scale, and the Social Support Rating Scale were used to collect data. Statistical analyses included descriptive statistics, t tests, ANOVAs, Pearson's correlation analyses and stepwise multiple linear regression. This study is reported according to the STROBE guidelines.

Results

In total, 156 out of 210 (74.29%) DR surgery patients experienced DD, with an average score of 2.13±0.63. The results of the stepwise multiple regression analysis showed that residential location, employment status, self-management level, family support, and social support were significantly associated with DD. These variables accounted for 30.6% of the total variation in DD.

Conclusions

DR surgery patients exhibit moderate levels of distress. Health care professionals should pay attention to DD in DR surgery patients and develop targeted interventions to improve the self-management ability of these patients, increase their family support and social support to reduce their DD levels.

Exploration of the hypoglycemic mechanism of Fuzhuan brick tea based on integrating global metabolomics and network pharmacology analysis

Introduction: Fuzhuan brick tea (FBT) is a worldwide popular beverage which has the appreciable potential in regulating glycometabolism. However, the reports on the hypoglycemic mechanism of FBT remain limited. Methods: In this study, the hypoglycemic effect of FBT was evaluated in a pharmacological experiment based on Kunming mice. Global metabolomics and network pharmacology were combined to discover the potential target metabolites and genes. In addition, the real-time quantitative polymerase chain reaction (RT-qPCR) analysis was performed for verification. Results: Seven potential target metabolites and six potential target genes were screened using the integrated approach. After RT-qPCR analysis, it was found that the mRNA expression of VEGFA, KDR, MAPK14, and PPARA showed significant differences between normal and diabetes mellitus mice, with a retracement after FBT treatment. Conclusion: These results indicated that the hypoglycemic effect of FBT was associated with its anti-inflammatory activities and regulation of lipid metabolism disorders. The exploration of the hypoglycemic mechanism of FBT would be meaningful for its further application and development.

The prevalence of diabetes distress in Chinese patients with type 2 diabetes: A systematic review and meta-analysis

OBJECTIVE

To systematically evaluate the prevalence of Diabetes Distress (DD) in type 2 diabetes mellitus (T2DM) patients in China.

METHODS

The PubMed, PsycInfo, Web of Science, The Cochrane Library, EMBASE, China Knowledge Resource in Integrated Database (CNKI), WanFang Database, Weipu Database (VIP), and Chinese Biomedical Database (CBM) electronic databases were searched from inception to August 2022, for cross-sectional studies, that reported prevalence of DD.

RESULTS

This study included 55 articles involving 13,160 patients with T2DM. The pooled prevalence of DD was 53.2%. The results of the subgroup analysis showed that among the five regions in China, the highest prevalence of DD was observed in Central China (66%), while the lowest prevalence was recorded in North China (23%). The highest prevalence of DD was 82% in unmarried people. while the lowest prevalence of DD among outpatients was as low as 42%. The results of meta-regression showed that there was no correlation between the prevalence of DD and the year of publication, the average age of the patients, or the duration of the disease.

CONCLUSION

More than half of T2DM patients in China may suffer from DD, which is not conducive to the self-management of diabetes patients. The burden on the healthcare system and the burden of disease on individual patients may increase as a result. Medical staff should pay attention to the monitoring and management of the mental health status of patients with T2DM.

Both short and long sleep durations are associated with type 2 diabetes, independent from traditional lifestyle risk factors-The Maastricht Study

OBJECTIVES

This study examined the cross-sectional association between sleep duration, prediabetes, and type 2 diabetes, and its independence from the traditional lifestyle risk factors diet, physical activity, smoking behavior, and alcohol consumption.

METHODS

Cross-sectional data from 5561 people aged 40-75 years recruited into The Maastricht Study between 2010 and 2018 were used (1:1 female:male and mean age: 60.1 years [standard deviation: 8.6]). Sleep duration was operationalized as in-bed time, algorithmically derived from activPAL3 accelerometer data (median 7 nights, IQR 1). Glucose metabolism status was determined with an oral glucose tolerance test. Multinomial logistic regression was used to assess the association of sleep duration as restricted cubic spline with prediabetes and type 2 diabetes. We adjusted for sex, age, educational level, the use of sleep medication or antidepressants, and the following lifestyle risk factors: diet quality, physical activity, smoking behavior, and alcohol consumption.

RESULTS

A U-shaped association between sleep duration and type 2 diabetes was found. Compared to those with a sleep duration of 8 hours, participants with a sleep duration of 5 and 12 hours had higher odds of type 2 diabetes (OR: 2.9 [95% CI 1.9 to 4.4] and OR 3.2 [2.0 to 5.2], respectively). This association remained after further adjustment for the lifestyle risk factors (OR: 2.6 [1.7 to 4.1] and OR 1.8 [1.1 to 3.1]). No such association was observed between sleep duration and prediabetes.

CONCLUSIONS

Both short and long sleep durations are associated positively and independently of lifestyle and cardiovascular risk factors with type 2 diabetes, but not with prediabetes.

The mediating role of diabetes stigma and self-efficacy in relieving diabetes distress among patients with type 2 diabetes mellitus: a multicenter cross-sectional study

Background

Patients with diabetes mellitus often suffer from diabetes distress. Social support and certain psychological factors potentially influence diabetes distress, but studies exploring the mechanisms underlying these relationships are scarce.

Objectives

To reveal the associations between social support, diabetes stigma, diabetes self-efficacy, and diabetes distress among patients with type 2 diabetes and the underlying mechanisms linking these variables.

Design and methods

A multicenter cross-sectional study was adopted and a sample of 431 patients with type 2 diabetes was investigated. Social support, diabetes stigma, diabetes self-efficacy, and diabetes distress were surveyed with the Perceived Social Support Scale, Type 2 Diabetes Stigma Assessment Scale, Self-Efficacy for Diabetes Scale, and Diabetes Distress Scale, respectively. The hypothesized model was verified using structural equation modeling.

Results

Social support and diabetes stigma had direct associations with diabetes distress. Diabetes stigma mediated the association between social support and diabetes distress, and the association between diabetes self-efficacy and diabetes distress. Diabetes stigma and self-efficacy exerted a chain mediation effect on the association between social support and diabetes distress.

Conclusion

Social support and diabetes stigma were significant predictors of diabetes distress. Diabetes stigma and self-efficacy play essential mediating roles in relieving diabetes distress. This can provide guidance for the development of evidence- and theory-based interventions. Culturally sensitive interventions that aim to provide ongoing social support, decrease diabetes stigma, and enhance self-efficacy have the potential to relieve diabetes distress.

The Prevalence and Correlates of Diabetes Distress among South Asians Living in New York City (NYC): Baseline Results from a Randomized Trial

Background

Type 2 diabetes (T2D) disproportionately affects South Asians in the United States (US). Living with T2D can be challenging due to the distress it can create for an individual. Distress associated with diabetes, commonly known as diabetes distress (DD), may lead to complications and challenges with the management of diabetes. This study aims to describe the prevalence of DD among a sample of South Asians in New York City (NYC) seeking care in community-based primary care settings and its association with sociodemographic characteristics and clinical measures.

Methods

This study utilized baseline data from the Diabetes Research, Education, and Action for Minorities (DREAM) Initiative, an intervention designed to reduce hemoglobin A1C (HbA1c) among South Asians with uncontrolled T2D in NYC. DD was measured using the Diabetes Distress Scale (DDS). First, descriptive statistics were used to analyze sociodemographic variables. Chi-square tests assessed categorical variables and Wilcoxon Rank Sum tests assessed continuous variables using a Type I error rate of 0.05. Logistic regression was performed to determine if HbA1c and mental health, along with other covariates, were associated with dichotomized DDS subscales.

Results

Overall, 415 participants completed the DDS at baseline. Median age was 56 years (IQR: 48-62). A total of 25.9% had high emotional burden distress, 6.6% had high physician-related distress, and 22.2% had high regimen-related distress based on subscales. In adjusted analyses, individuals with any days of poor mental health had significantly higher odds of overall distress (OR:3.7, p=0.014), emotional burden distress (OR:4.9, p<0.001), and physician-related distress (OR:5.0, p=0.002) compared to individuals with no days of poor mental health. Individuals with higher HbA1c had significantly higher odds of regimen-related distress (OR:1.31, p=0.007).

Conclusions

Findings suggest that DD is prevalent among this sample of South Asians with diagnosed T2D in NYC. Screening for DD in patients with prediabetes/diabetes should be considered by providers to help provide mental and physical health services during primary care visits. Future research can also benefit from a longitudinal analysis of the impact of DD on diabetes self-management, medication adherence, and mental and physical health.

Trial registration

This study uses baseline data from "Diabetes Management Intervention For South Asians" (NCT03333044), which was registered with clinicaltrials.gov on 6/11/2017.

Factors associated with diabetes-related distress among Asian patients with poorly controlled type-2 diabetes mellitus: a cross-sectional study in primary care

BACKGROUND

Diabetes-related distress (DRD) is a negative emotional state related to the burden of living with diabetes mellitus. It has been associated with poor self-care and glycaemic control. This cross-sectional study aimed to examine the factors associated with DRD among urban Asian patients with poorly controlled type-2 diabetes mellitus (T2DM) in primary care in Singapore. The factors included demographics, diabetes history, medical co-morbidities, mood disorders and social history.

METHODS

Patients with T2DM and HbA1c of 8% or more were recruited from 2 public primary care centres in Singapore. They were administered a questionnaire survey to identify DRD based on the Problem Area In Diabetes (PAID) scale. Their anxiety and depression were screened using GAD-7 and PHQ-9, and quality of life (QOL) measured using the EQ-5D-5L. Their clinical data, including HbA1c, comorbidities and medications, were extracted from the electronic medical records.

RESULTS

Among the 356 subjects, the prevalence of DRD was 17.4%. DRD was significantly associated with younger age (AOR (95% CI) = 0.93 (0.89-0.97), p = 0.001), ex-smoker status (AOR (95% CI) = 22.30 (2.43-204.71), p = 0.006) and history of kidney disease (AOR (95% CI) = 3.41 (1.39-8.35), p = 0.007). Those who screened positive for depression (AOR (95% CI) = 4.98 (1.19-20.86), p = 0.028) were almost five times more likely to have DRD. Quality of life was lower among those with DRD (EQ5D index score AOR (95% CI) = 0.11 (0.01-0.97), p = 0.047), who also tended to feel that diabetes pharmacotherapy interfered with their normal life (AOR (95% CI) = 2.89 (1.38-6.08), p = 0.005).

CONCLUSION

About 1 in 6 patients with poorly controlled T2DM had DRD. Younger age, ex-smoker status, history of kidney disease, and those with depressive symptoms were most at risk.

Self-compassion, sleep quality and psychological well-being in type 2 diabetes: a cross-sectional study

INTRODUCTION

Low self-compassion and poor sleep quality have been identified as potential key predictors of distress in type 2 diabetes (T2D). This study investigated relationships between sleep behaviors (sleep duration, social jetlag and daytime sleepiness), diabetes-related distress (DRD) and self-compassion in people with T2D.

RESEARCH DESIGN AND METHODS

This cross-sectional study used data from 467 people with T2D derived from self-report questionnaires, accelerometer-assessed sleep measures and demographic information (clinicaltrials.gov registration: NCT02973412). All participants had a diagnosis of T2D and no comorbid sleep disorder (excluding obstructive sleep apnea). Hierarchical multiple regression and mediation analysis were used to quantify relationships between self-compassion, sleep variables and DRD.

RESULTS

Significant predictors of DRD included two negative subscales of the Self-Compassion Scale (SCS), and daytime sleepiness. The 'overidentified' and 'isolation' SCS subscales were particularly important in predicting distress. Daytime sleepiness also partially mediated the influence of self-compassion on DRD, potentially through self-care around sleep.

CONCLUSIONS

Daytime sleepiness and negative self-compassion have clear associations with DRD for people with T2D. The specific negative subscale outcomes suggest that strengthening individuals' ability to mindfully notice thoughts and experiences without becoming enmeshed in them, and reducing a sense of separateness and difference, might be key therapeutic targets for improving well-being in T2D. Psychological interventions should include approaches focused on reducing negative self-compassion and improving sleep behavior. Equally, reducing DRD may carry beneficial outcomes for sleep and self-compassion. Further work is however crucial to establish causation and long-term impact, and for development of relevant clinical resources.

Impact of fear of hypoglycaemia on self-management in patients with type 2 diabetes mellitus: structural equation modelling

AIMS

This study aimed to explore the effect of fear of hypoglycaemia (FOH) on self-management and its specific action path in patients with type 2 diabetes mellitus (T2DM) to provide a basis for developing targeted nursing interventions.

DESIGN

A cross-sectional study.

METHODS

From June to October 2019, we recruited 258 patients with T2DM from the endocrinology department of three hospitals to complete questionnaires, including the Hypoglycaemia Fear Survey-II, Diabetes Distress Scale, Self-Stigma Scale, Social Support Rating Scale and Summary of Diabetes Self-Care Activities, in Jiangsu Province, China. Pearson's correlation analyses and structural equation modelling were conducted to explore the relationship and influence path among the above variables.

RESULTS

The correlation analysis of FOH, distress, self-stigma, social support and self-management showed that, except for social support not being correlated with FOH and distress (P > 0.05), all variables were correlated in pairs (r = - 0.19-0.77, P < 0.01). The final model fit well, and the fitting indexes of the model were as follows: χ²/df = 2.191, GFI = 0.934, CFI = 0.954, TLI = 0.934, RMSEA = 0.068, and SRMR = 0.0649. The effects of FOH on self-management in patients with T2DM included one direct path and two indirect paths: (a) FOH had a direct impact on self-management (P < 0.05); (b) FOH had an indirect impact on self-management through distress (P < 0.05); and (c) FOH had an indirect impact on self-management through self-stigma and social support (P < 0.05).

CONCLUSIONS

FOH could directly influence self-management in patients with T2DM. Furthermore, distress, self-stigma and social support were important mediating variables of FOH influencing self-management. Researchers can develop personalized interventions to improve the self-management of patients with T2DM by regulating distress, self-stigma and social support levels.

Sleep Quality among Patients with Type 2 Diabetes: A Cross-Sectional Study in the East Coast Region of Peninsular Malaysia

Poor sleep is related to type 2 diabetes and adversely influences a person’s quality of life. This study aimed to evaluate sleep quality in patients with type 2 diabetes (T2DM), its associated factors, and its relationship with quality of life. A cross-sectional study was conducted at a primary care clinic in a tertiary hospital on the east coast of Malaysia. This study included 350 participants (175 men and 175 women). Data were collected using the Malay version of the Pittsburgh Sleep Quality Index (PSQI-M) with a cut-off point of >5 as poor sleep, the Malay version of Diabetes Distress Scale (MDDS-17) and the revised Malay version of T2DM-related quality of life (Rv-DQOL). Statistical analysis was conducted using the SPSS software version 26.0. The respondents’ median (interquartile range (IQR)) age was 62.0 (11.0) years, and poor sleep was reported in 32% (95% confidence interval (CI) = 27.1, 36.9) of the participants. Multivariate logistic regression analysis revealed that poor sleep quality was significantly associated with nocturia (odds ratio (OR) = 2.04; 95% CI = 1.24, 3.35), restless legs syndrome (OR = 2.17; 95% CI = 1.32−3.56) and emotional burden (OR = 2.37; 95% CI = 1.41−3.98). However, no statistically significant association was observed between sleep quality and quality of life among our participants.

Quality of Life in University Students with Diabetes Distress: Type 1 and Type 2 of Diabetes Differences

BACKGROUND

This study constitutes a preliminary trial to clarify the relationship between quality of life (QoL) and diabetes distress (DD in patients with diabetes mellitus (DM) by comparing patients with type 1 and type 2 diabetes.

METHODS

A cross-sectional study of university students with diabetes (type 1 and type 2) diabetes. One hundred sixty-six students were assigned to participate in this study. A self-report questionnaire on demographic and clinical parameters was taken. Rating worries and anxieties related to diabetes were evaluated using the diabetes distress scale-17, and quality of life was tested using SF-36 v2.

RESULTS

No significant differences were observed in the level of DD according to sociodemographics in type 1 DM (T1DM) and type 2 DM (T2DM) (p > 0.05). The mean scores for Physical Component Summary (PCS) and Mental Component Summary (MCS) and six subscales of the SF-36 v2 demonstrated no significant differences between T1DM and T2DM (p > 0.05). High scores of diabetes distress were independently associated with lower glycemic control for students with both types of diabetes. Likewise, high scores of distress were associated with lower PCS (p < 0.05). Additionally, the results showed that high scores of diabetes distress were associated with lower MCS (p < 0.05).

CONCLUSIONS

University students with diabetes showed a high level of DD with no significant differences between both types of diabetes; this consequently affects all components of QoL. Psychological support is the better choice for those students for better health and future career.

Factors Associated with Diabetes-Related Distress in Type 2 Diabetes Mellitus Patients

BACKGROUND

Diabetes-related distress is a unique emotional problem that is directly related to the burden and anxieties felt by type 2 diabetes mellitus (T2DM) patients. Diabetes-related distress may lead to pessimism and lower self-efficacy which resulted in a deficiency of self-treatment compliance and can cause further bad glycemic control. Knowing the associated factors of diabetic-related distress and solving them may help T2DM patients improve their glycemic control.

METHODS

This study is an analytical study with cross-sectional design conducted at Sanglah General Hospital from January to April 2021. The data were taken using the consecutive sampling method; 124 samples were collected according to inclusion and exclusion criteria. The participants filled Diabetes Distress Scale questionnaire (DDS17 Bahasa Indonesia). The data analysis was done using univariate (descriptive), bivariate (chi-square) and multivariate (logistic regression) analysis.

RESULTS

Seventy-five subjects out of 124 (60.5%) had diabetes-related distress. The associated factors of diabetes-related distress one among others are the insulin usage as diabetic therapy (OR= 8.30, 95% CI 2.24-30.72; p = 0.002), had a hypoglycaemia in last 3 months (OR=44.59, 95% CI 4.36-455.51; p = 0.001), had diabetes-related retinopathy (OR=10.28, CI 95% 1.54-68.70; p=0.016), and lack of family support (OR=44.791, 95% CI 10.02-200.22; p < 0.001).

CONCLUSION

Our present study revealed that diabetes distress prevalence is predominantly and associated among in type 2 diabetes mellitus. We suggest diabetes-related distress screening and regular health promotion which focus on relationship between diabetes and psychological may be a great potential action to improve public health and patient outcomes.

Assessing the Prevalence of Diabetes Distress and Determining Its Psychosocial Predictors Among Saudi Adults With Type 2 Diabetes: A Cross-Sectional Study

In recent years, the global burden of diabetes distress has increased significantly worldwide, imposing mental health issues on patients and the healthcare system. Hence, this study aimed to estimate the prevalence of diabetes distress and determine its psychosocial predictors among Saudi adults with type 2 diabetes mellitus (T2DM). This cross-sectional, observational study was conducted at Diabetes Clinics, Tertiary Care Academic Medical Center, King Saud University Medical City, Riyadh, Saudi Arabia. The survey questionnaire was distributed to 423 participants. The sample size was 384, where the prevalence of diabetes distress was 48.5%. Based on 5% precision and a confidence interval of 95%, the response rate was 78.25% (334 respondents), among which 61.4% of respondents were females, the remaining 38.6% were males, and the mean age was 56.39 years. The mean scores for the Saudi Arabian Diabetes Distress Scale-17 (SADDS-17) subdomains including emotional burden, physician-related distress, regimen-related distress, and interpersonal distress were 2.63 ± 1.29, 2.31 ± 1.44, 2.48 ± 1.16, and 2.23 ± 1.24, respectively. Based on the World Health Organization Quality of Life Assessment Instrument, Short Version (WHOQOL-BREF) transformed scores, the quality of life was recorded as 62.7%. There was a statistically significant positive correlation between the Hospital Anxiety and Depression Scale (HADS) score (r = 0.287, p < 0.01) and the total SADDS-17 scores. The Patient Health Questionaire (PHQ) 15 scores showed significant positive correlations with the total SADDS-17 scores (r = 0.288, p < 0.01) and each of the four subdomains. Our present study revealed that diabetes distress prevalence is alarmingly high among patients in Saudi Arabia, Riyadh. Our findings provide evidence that physical symptoms, quality of life, depression, and anxiety are the notable predictors of diabetes distress.

Prevalence and Determinant Factors of Diabetes Distress in Community-Dwelling Elderly in Qom, Iran

Background:

Diabetes distress (DD) is common among the patients with type 2 diabetes (T2D), but few studies investigated this problem and its related factors in the elderly population. This study has focused on the prevalence rate of DD and its determinants in community-dwelling elderly in Qom, Iran.

Methods:

This study was cross-sectional. A total of 519 subjects community-dwelling with T2D participated in the study. Collected data contained sociodemographic information, some clinical variables (body mass index and duration of diabetes) knowledge, attitude, and self-efficacy. Participants' distress was measured via diabetes distress scale (DDS). The cut of 3 (≥3) was considered as the presence of distress. Also, the attitude, self-efficacy, and knowledge about diabetes were measured by questioner. Multiple logistic regression analysis was applied to detect predictors of DD.

Results:

The mean age of the participants was 68.38 ± 6.78 and 53.6% were female. Among the participants, 48.6% were identified with positive DD. According to the results of logistic regression analysis, being female (odds ration [OR] = 1.688, P = 0.009), being widowed or divorced (OR = 1.629, P = 0.027), being over-weight or obese (OR = 1.627, P = 0.027), and having less than 10 years in disease duration (OR = 1.721, P = 0.029), attitude (OR = 0.590, P < 0.001), and self-efficacy (OR = 0.658, P = 0.009) were identified as the independent predictors of DD. No significant association was found between DD and age, occupational status, education level, and knowledge (P > 0.05).

Conclusions:

The prevalence of DD is considerable among the elderly in Qom. It seems that more attention should be paid to the mental aspects of the patients with T2D specially in high risk groups.

Effectiveness of a nurse-led mindfulness stress-reduction intervention on diabetes distress, diabetes self-management, and HbA1c levels among people with type 2 diabetes: A pilot randomized controlled trial

People with diabetes frequently have elevated diabetes distress. Although mindfulness-based stress reduction (MBSR) therapy has been shown effective in reducing diabetes distress, it has only been delivered by psychologists or a multidisciplinary team with an attrition rate of up to 39%, which limits its dissemination to a broader audience. This study was aimed to pilot evaluate the feasibility of a nurse-led MBSR therapy and explore its potential efficacy amongst people with type 2 diabetes mellitus. A total of 100 participants were randomly allocated either to the intervention group (nurse-led MBSR therapy + regular diabetes education) or the control group (regular diabetes education). Data on diabetes distress, diabetes self-efficacy, and diabetes self-management were collected at baseline, 8 and 12 weeks. Hemoglobin A1c (HbA1c) was collected at baseline and 12 weeks. A generalized estimating equation analysis for repeated measures was used to determine intervention and time effects. As predicted, the nurse-led MBSR therapy had a significant time-by-group interaction effect on diabetes distress total score (95% confidence interval [CI]: 0.58-0.77, p < 0.001), diabetes self-efficacy (95% CI: -0.93 to -0.74, p < 0.001), diabetes self-management (95% CI: -10.80 to -7.83, p < 0.001), and HbA1c levels (95% CI: 0.04-1.14, p = 0.03) in the intervention group compared with the control group over 12 weeks. This is the first nurse-led MBSR therapy in a hospital setting that is feasible and has the potential to improve health outcomes. This approach may offer an innovative model to deliver MBSR therapy. A randomized controlled trial comparing the nurse-led MBSR plus usual diabetes education with usual diabetes education along with a mechanism to equalize intervention attention between the groups is indicated.

Assessment of diabetes-related distress among type 2 diabetic patients, Riyadh, Saudi Arabia

OBJECTIVES

To assess the prevalence of diabetes-related distress (DRD) among Type 2 diabetics in the diabetic center of King Salman Hospital, Riyadh, Saudi Arabia.

METHODS

This was an observational descriptive study conducted between December 2019 and January 2020 among T2DM patients followed up at the diabetic clinics of the Diabetic Center of King Salman Hospital in Riyadh, Saudi Arabia. We used the 17-items Diabetes Distress Scale (DDS17) to measure DRD.

RESULTS

A total of 399 T2DM patients were included in the study, 58.4% were males. High distress was seen in 40 patients. Multivariate analysis showed that longer duration of diabetes (>15 years), female gender, longer intervals in-between visits (>6 months), and experience of episodes of severe hypoglycemia as the most significant factors related to higher levels of distress. The patients who were diabetics longer than 15 years had an increased risk for high distress by 3.6 times, infrequent clinic visits (longer than 6 months) increased the risk for high distress by 5.3 times×, and patients who experienced severe hypoglycemia had an increased risk for high distress by 5.8 times.

CONCLUSION

This study showed a high (35.6%) prevalence of moderate to severe DRD. Long-standing diabetes, a longer interval of a clinic visit, and severe hypoglycemia increase the risk for DRD by 3.6, 5.3, and 5.8 folds. Health care providers should focus on reducing DRD and devise ways to increase self-care practices and coping skills.

Telemedicine assists in the management of proatherogenic dyslipidemia and postprandial glucose variability in patients with type 2 diabetes mellitus: a cross-sectional study

OBJECTIVE

Coronary heart disease (CHD) is a prevalent complication of type 2 diabetes mellitus (T2DM). The proatherogenic low-density lipoprotein (LDL) cholesterol is an established risk factor of cardiovascular disease, and evidence also suggests that postprandial plasma glucose (PPG) levels closely delineate CHD mortality in diabetes. The investigators hypothesized that the addition of telehealth consultation to standard antidiabetic therapy may help to reduce postprandial glucose variability and plasma LDL cholesterol levels in patients with T2DM.

METHODS

This cross-sectional study enrolled patients with newly diagnosed T2DM who received standard antidiabetic therapy with or without additional telehealth consultation. Participants received blood tests for plasma lipid profile and glucose levels at the diagnosis of diabetes and after 1 month of therapeutic intervention. Laboratory results were compared between treatment groups to determine the efficacy of complementary telehealth consultation.

RESULTS

In this study, 375 participants were enrolled. The standard treatment group had considerably greater levels of plasma LDL cholesterol than recipients of telehealth consultation (110 mg/dL vs 93.1 mg/dL, P < 0.001). Moreover, patients receiving standard treatment had greater levels of fasting plasma glucose (104 mg/dL vs 98.5 mg/dL, P = 0.027), 2-h PPG (169 mg/dL vs 111 mg/dL, P < 0.001), and postprandial glucose variability (65.4 mg/dL vs 12.8 mg/dL, P < 0.001) than participants under telehealth consultation.

CONCLUSIONS

Telemedicine in addition to standard antidiabetic therapy helped to reduce plasma LDL cholesterol levels and postprandial glucose variability in patients with newly diagnosed T2DM. Therefore, telehealth consultation is a suitable complement to pharmacologic therapy for diabetic patients to assist in the management of proatherogenic dyslipidemia and postprandial glucose variability.

Development of a Family Support Scale for Diet Therapy for Male Workers with type 2 diabetes

AIM

Dietary self-care for patients with type 2 diabetes can be improved with family support. The purpose of this study was to develop a scale to assess family support for diet therapy for male workers with type 2 diabetes and to examine its reliability and validity.

METHODS

In this cross-sectional study, we collected data from 110 Japanese male workers with type 2 diabetes. Data were analyzed using exploratory factor analysis, reliability testing, and validity testing.

RESULTS

The resultant Family Support Scale for Diet Therapy for Male Workers (FSS-DMW) with type 2 diabetes consisted of 31 items and a six-factor structure. The six factors explained 72.9% of the variance, and Cronbach's alpha for the total scale was .964. The scale correlated as expected with the Social Support Scale for Chronic Illness and the dietary subscale of the Japanese version of the Summary of Diabetes Self-Care Activities Measure.

CONCLUSION

The FSS-DMW is a reliable and valid measure which can be used to assess family support for diet therapy for male workers with type 2 diabetes and has the potential to be used as a clinical instrument for family guidance.

Predictors of diabetes distress among older persons with type 2 diabetes mellitus in Indonesia

Background

Older persons living with diabetes have an obligation to change their daily lifestyle, which may contribute to diabetes distress. Furthermore, predictive factors of diabetes distress in older persons might be different from other age groups due to age-related factors.

Aims

The purpose of the study was to examine the predictive factors of diabetes distress in older persons diagnosed with type 2 diabetes mellitus (T2DM) in Indonesia.

Methods

A cross-sectional design was used in this study. Participants were recruited from an outpatient department of a tertiary hospital in Klaten City, Central Java, Indonesia. Data were analysed using multiple linear regression with a stepwise method.

Results

A total 198 older persons were included in the study. The study demonstrated self-efficacy (β = −0.298, P < 0.01), spirituality (β = −0.139, P < 0.05), blood glucose (β = 0.134, P < 0.05), and non-supportive family behaviour (β = 0.135, P < 0.05) as the variables that could statistically predict diabetes distress in older persons with T2DM.

Conclusions

Self-efficacy is the strongest predictor of diabetes distress. Moreover, the findings can be used as evidence to guide identification and future management of diabetes distress among older persons with T2DM.

Distress and depression among patients with diabetes mellitus: prevalence and associated factors: a cross-sectional study

PURPOSE

This study aimed to validate the internal consistency of the Persian version of the diabetes distress scale-17 (DDS-17) and to investigate the prevalence of diabetes distress (DD), depression, and possible relevant factors.

METHODS

This was a cross-sectional study on 820 diabetes patients (62.4 % females) in Tehran, Iran between January and June 2017. The Ethics Committee of Shahid Beheshti University of Medical Sciences approved the protocol. Patients filled out a demographic and health survey, DDS-17, the Beck Depression Inventory Second Edition (BDI-II) and the Summary of Diabetes Self-Care Activities Measure (SDSCA). DDS-17 consist of emotional burden, and physician, regimen, and interpersonal related distress. The correlation between DDS subscales and association between DDS and BDI-II or SDSCA scores were assessed using SPSS.

RESULTS

The mean age was 58.91 ± 12.35 years. Majority of patients had high DD (37.2 %) and severe depression (38.7 %). The general and specific diets got the highest score in six SDSCA subscales. The Persian version of DDS-17 had excellent internal consistency with Cronbach's alpha coefficient of 0.924. The DDS score had significant relationship with socioeconomic level (p < .001), type of DM (p < .001), type of treatment (p < .001), glycemic control status (p < .001), complication (p < .001) and depression level (p < .001). The level of hemoglobin A1c was the most useful predictor of DDS score (p < .001).

CONCLUSIONS

High prevalence of depression and distress in patient with diabetes calls for greater emphasizes on the importance of enhanced physicians and patients' knowledge in these areas.

The association between diabetes-related distress and fear of hypoglycaemia in patients with type 2 diabetes mellitus: A cross-sectional descriptive study

AIM

The study aimed to explore the association between diabetes-related distress as a dependent variable and fear of hypoglycaemia as a independent variable in Chinese individuals with type 2 diabetes, which can provide a basis for the development of effective nursing interventions.

DESIGN

A cross-sectional descriptive study.

METHODS

Pre-piloted scales were used to determine whether they experienced fear of hypoglycaemia and whether this impacted upon their management of the disease. From June-October 2019, participants were asked to complete the "hypoglycaemia fear survey" and "diabetes distress scales" to assess levels of fear and distress. Stepwise multivariate regression analysis was applied to reveal relationship between distress as a dependent variable and fear as a independent variable. Covariates included demographic, clinical or lifestyle factors.

RESULTS

A total of 258 participants were recruited for the survey, and they were characterized by little or no distress (39.53%), moderate distress (45.35%) and high distress (15.12%). The prevalence of moderate to severe distress in patients was 60.47%. Increased diabetes-related distress was strongly correlated with increased fear of hypoglycaemia and closely associated with the scores of the worry and behaviour subscales. These results indicated that 62.3% of diabetes-related distress may be explained by fear of hypoglycaemia.

CONCLUSION

Increased diabetes-related distress is associated with increased fear of hypoglycaemia in individuals with type 2 diabetes.

Prevalence of Diabetes Related Distress and Associated Factors Among Type 2 Diabetes Patients Attending Hospitals, Southwest Ethiopia, 2020: A Cross-Sectional Study

INTRODUCTION

Diabetes related distress is the most common psychological co-morbid condition among type 2 diabetes patients. However, although the number of people living with diabetes has continued to increase over the last 10 years, information regarding diabetes related distress is limited in Ethiopia.

OBJECTIVE

The present study aimed to assess the prevalence of diabetes related distress and associated factors among type 2 diabetes patients attending hospitals in Southwest Ethiopia.

METHODS

A cross-sectional study was employed on 360 type 2 diabetes patients attending hospitals from January 1 to March 30, 2020. Convenient sampling technique was used to select study participants. Data were entered into EpiData manager version 4.2.2 and exported to Statistical Package for the Social Sciences (SPSS) version 20.0 and analyzed using descriptive statistics, bivariate and multivariate logistic regressions. The statistical significance was set at P < 0.05.

RESULTS

Out of a total 360 patients recruited, 321 (89.2%) patients (201 male and 120 female) were involved in the study. The mean age of the participants was 41.3 (SD = 12.8) years. The prevalence of diabetes related distress was 118 (36.8%) in which emotional distress was the most prevalent (43.6%) domain. Level of education [AOR 4.55; 95% CI: 1.28-16.19], family or social support [AOR 0.62; 95% CI: 0.33-1.06], duration of diabetes [AOR 0.75; 95% CI: 0.35-1.55], having diabetes complications [AOR 1.98; 95% CI: 1.0-3.86], smoking status [AOR 1.6; 95% CI: 1.12-2.97] and alcohol consumption status [AOR 1.4; 95% CI: 1.07-2.53] were the identified factors of diabetes related distress.

CONCLUSION

Diabetes related distress was highly prevalent in type 2 diabetes patients. Healthcare providers need to address this through integrating psychosocial care with collaborative medical care.

Diabetes-Related Distress Among People with Type 2 Diabetes in Ho Chi Minh City, Vietnam: Prevalence and Associated Factors

BACKGROUND

Diabetes-related distress (DRD) refers to the condition of negative emotion as a result of living with diabetes and the burden of self-care. This study aims to evaluate the prevalence and associated factors of DRD among people with type 2 diabetes.

METHODS

A cross-sectional study was carried out on people with Type 2 Diabetes at three hospitals in Ho Chi Minh City, between April and November 2020. The study used the Vietnamese version of the Diabetes Distress Scale (DDS) which includes 17 items. The mean total distress score was calculated on the average of the 17 items. A mean score of equal to 2.0 or higher was classified as moderate to severe distress. Descriptive statistics were performed by frequency and percentage, and the multivariate Logistic Regression Analysis was used to assess information where p-value <0.05 was considered statistically significant.

RESULTS

A total of 517 participants, who were mainly over 60 years old (56.8%) with females being 65.0%, participated in the study. Results showed that 23.6% and 5.8% of them, respectively, were found as being moderately or highly distressed. Some factors that correlated with the total distress results included age, timescale of diabetes, and glycemic control level (HbA1c). The rate of total distress in those who were over 60 years old and had a HbA1c <7 were less prevalent than those who were under 60, and had a HbA1c ≥7 (OR 0.5 95% CI 0.3-0.7; OR 0.5 95% CI: 0.3-0.9, respectively, all p<0.05), whilst the timescale of diabetes between 5 and 10 years was significantly more prevalent than those who had a timescale less 5 years (OR 1.8 95% CI 1.1-2.9, p<0.05).

CONCLUSION

A high rate of distress exists in people with diabetes. Therefore, combining the evaluation of distress as part of the regular diagnostic procedures of diabetes care, and recommending physicians apply a comprehensive approach to diabetes management, is necessary.

Factors associated with loneliness in patients with diabetes mellitus

Aim

To (a) explore the prevalence of loneliness in patients with diabetes mellitus and (b) identify loneliness-related factors in the group of hospitalized patients with diabetes mellitus.

Design

A cross-sectional study.

Methods

The study included 248 patients with diabetes mellitus who were staying in six Polish hospitals. A questionnaire including sociodemographic and clinical data, and the Revised UCLA Loneliness Scale (R-UCLA), was used for research data collection. Data were collected from March 2019 to June 2019.

Results

Patients with diabetes generally experience moderate loneliness, with almost one-fifth (16%) of patients experiencing intense loneliness. The patients scored a mean 9.94 out of a possible 20 in belongings and affiliation category and 20.14 out of a possible 40 in the intimate others category. Lower education, being single and the presence of chronic complications of diabetes mellitus were risk factors for increased loneliness.

Diabetes-Related Distress and Its Associated Factors Among Patients with Diabetes in Vietnam

Background

Psychometric properties are regarded as one of the significant contributors related to diabetes treatment efficacy. Diabetes-related distress (DD) is one of the emotional burdens. The aims of this study were to investigate the prevalence of DD and to determine its associated factors among Vietnamese diabetic patients.

Methods

A cross-sectional study was conducted at a single medical center in the central of Vietnam. A total of 138 eligible DM outpatients were invited and a total of 112 patients who completed the questionnaire were utilized in this analysis using convenience sampling. DD was assessed using the diabetes distress scale (DDS). The participant’s sociodemographic and clinical information was obtained through face-to-face interviews and medical records. Multivariate logistic regression was used to determine independent factors associated with the presence of DD.

Results

Approximately, 12.5% of the patients experienced DD based on DDS self-administered questionnaire. The rates of mild/moderate and high distress were 8.0% and 4.5%, respectively. DD was found to be significantly higher in type 1 DM (p=0.04), insulin only in treatment regime (p=0.04), physical inactivities (p=0.02), times of mild hypoglycemia (time/month) (p=0.01), and fasting plasma glucose (mmol/l) (p=0.04). The occurrence of distress among DM patients was negatively correlated with their age and amount of physical exercise. Meanwhile, poor HbA1c control (HbA1c≥7%) was associated with an increased occurrence of diabetes distress.

Conclusion

The findings of single medical center in Vietnam highlights that DD is prevalent among DM patients. It should be of marked concerns, particularly the type 1 diabetic patients, younger age, and poor glycemic control patients.

Diabetes distress is associated with individualized glycemic control in adults with type 2 diabetes mellitus

PURPOSE

It has been proposed that the negative emotional state of diabetes distress (DD) may exert a detrimental effect on glycemic outcomes of individuals struggling with diabetes-related challenges. Thus far, no study has investigated this association by utilizing individualized treatment targets of patients' glycemic control. Therefore, we sought to identify the potential role of DD in the achievement of individualized glycemic targets (AIGTs) among persons with type 2 diabetes mellitus (T2D).

METHODS

This cross-sectional study included a well-characterized outpatient group of T2D adults cared for in an academic medical center. DD was evaluated with the Diabetes Distress Scale. The AIGTs was defined according to the American Diabetes Association guidelines. Logistic regression analyses were utilized to identify independent correlates of the AIGTs.

RESULTS

A total of 123 individuals (mean [standard deviation] age: 58.0 [6.2] years, 55.3% females) were included in the final analysis. AIGTs was observed in 43.9% of the patients. Experiencing greater DD was associated with a lower likelihood of AIGTs (unadjusted odds ratio [OR]: 0.17, 95% confidence interval [CI]: 0.08-0.34, P value < 0.001), even after accounting for additional individual-level covariates (adjusted OR: 0.18, 95% CI: 0.08-0.42, P value < 0.001). Medication adherence was also a determinant of participants' AIGTs (adjusted OR: 1.91, 95% CI: 1.13-3.23, P value = 0.015).

CONCLUSION

Our findings provide novel evidence that DD likely undermines glycemic status in adult outpatients with T2D, even in the context of individually tailored diabetes care, and this should be taken into account when necessary.

Not Scared of Sugar™: Outcomes of a structured type 2 diabetes group education program for Chinese Australians

Type 2 diabetes disproportionately affects the Chinese population yet there are no structured diabetes education programs specifically designed for this community in Australia. This project aimed to develop and evaluate a pilot type 2 diabetes group education program designed specifically for Chinese migrants living in Australia. A non-randomised pre- versus post-intervention trial was conducted between March 2017 and November 2018. A culturally tailored group education program (Not Scared of Sugar™) was developed and piloted with Melbourne-based Cantonese-speaking people with type 2 diabetes. Program teaching styles were aligned with the Confucian cultural process of learning and incorporated culturally specific strategies to promote healthy behaviour change. Thirty-four individuals (35% male) attended five education sessions over ten weeks, delivered by a Cantonese-speaking facilitator and multidisciplinary clinicians. Data were collected from participants at baseline, on program completion and at 6 months follow-up. Mean (SD) participant age was 69 (9) years, with a mean time of 25.7 (10.8) years in Australia and a median duration of diabetes of 10 (IQR = 2.8-20.5) years. At program completion, mean participant waist circumference (90.5 versus 89.2 cm, p < .001) and waist-to-height ratio (0.574 vs. 0.566, p < .001) was significantly reduced and both were further reduced at 6-month follow-up (p < .05). There was a significant increase in the median frequency of diabetes self-care behaviours undertaken, with American Association of Diabetes Educators Questionnaire Score: 30 (22-32.3) versus 33 (29.8-35.0), p < .001 at 6-month follow-up. Diabetes-related distress assessed by PAID-C was also significantly reduced at 6-month follow-up (p < .05). Mean HbA1c was unchanged after 6 months; 51 (7.9) versus 50 (7.8) mmol/mol, p = .316. Program attrition was 6%. Not Scared of Sugar™ successfully reduced waist circumference, increased diabetes self-management behaviours and reduced diabetes distress in Cantonese-speaking Australians, which may positively impact long-term risk of vascular complications.

Psychosocial distress, clinical variables and self-management activities associated with type 2 diabetes: a study in Ghana

Aim

Psychosocial distress can act as a barrier to diabetes self-care management and thus compromise diabetes control. Yet in Ghana, healthcare centres mainly focus on the medical aspect of diabetes to the neglect of psychosocial care. This study determined the relationship amongst psychosocial distress, clinical variables, and self-management activities associated with type 2 diabetes management.

Method

Questionnaires were administered to 162 patients from four hospitals in Accra, Ghana, to assess psychosocial distress (e.g. diabetes distress), clinical variables (e.g. glycaemic control), and self- management activities (e.g. medication intake) related to diabetes. In assessing diabetes distress, the use of the PAID allowed evaluation of broader range of emotional concerns (diabetes-related emotional distress), while the DDS allowed evaluation of factors more closely related to diabetes self-management (diabetes distress).

Results

Diabetes-related emotional distress, diabetes distress and depressive symptoms were reciprocally positively correlated, while non-supportive family behaviour correlated negatively with these psychological variables. Diabetes-related emotional distress correlated positively with systolic and diastolic blood pressure, and correlated negatively with exercise regimen. On the other hand, diabetes distress correlated negatively with dietary and exercise regimen and correlated positively with glycaemic levels, while depressive symptoms correlated positively with glycaemic levels, diabetes complication and systolic blood pressure. Contrary to the literature, non-supportive family behaviour correlated positively with diet, exercise and medication regimen.

Conclusion

The positive association of psychological variables with glycaemic levels and blood pressure levels, and the positive association of non-supportive family behaviour with self-management activities suggests the need for psychosocial care to be incorporate in the management of type 2 diabetes in Ghana. Patients can be screened for diabetes-related distress and symptoms of depression and provided psychosocial care where necessary.

When qualitative data contradict quantitative data: diabetes distress in the Chinese-Canadian community

AIMS

To use both quantitative and qualitative approaches to characterize the diabetes distress profile of Chinese-Canadians with Type 2 diabetes and to better understand their experience of living with diabetes.

METHODS

We recruited 40 Chinese-Canadian adults with Type 2 diabetes who completed a Mandarin- or Cantonese-language diabetes education programme in Richmond, British Columbia. Using a mixed-methods sequential explanatory research design, participants first completed a 15-item Chinese version of the Diabetes Distress Scale, which included three subscales: emotional burden, regimen-related distress, and physician distress. The self-report survey was followed by a semi-structured interview that addressed the following diabetes-related topics: perspectives towards the healthcare team, emotional health, diabetes-related concerns and stressors, diabetes diagnosis experience, and sources of social support and diabetes education.

RESULTS

The mean (sd) scores for total distress 1.5 (0.5), emotional burden 1.7 (0.7), regimen-related distress 1.4 (0.5), and physician distress 1.4 (0.9), fell within the 'low distress' range (< 2.0). Qualitative analysis of semi-structured interviews showed that some participants were dissatisfied with diabetes care providers and experienced emotional challenges, particularly early in their diagnosis. Other themes that emerged included eating distress, fear of complications, language barriers, and medication concerns.

CONCLUSIONS

Not only did the qualitative findings from semi-structured interviews capture aspects of diabetes distress that were not included in the quantitative survey, it also uncovered inconsistencies between the two datasets. To more accurately understand the diabetes distress experience of any ethnic community, both quantitative and qualitative approaches contribute unique value.

The prevalence and predictors of diabetes distress in elderly with type 2 diabetes mellitus

AIMS

Diabetes distress (DD) leads to damaging consequences in patients with type 2 diabetes mellitus (T2DM). Few studies have been carried out on the DD among elderly in Iran. The aim of the current study was to investigate the prevalence of DD and some of its related factors on the elderly living in Qom, Iran.

METHODS

This study was cross-sectional, in design. It lasted for three months (December to February 2018). 519 community dwelling(aged 60 and over) participated in the study. Participants' distress measured by diabetes distress scale (DDS). The cut of 3(≥3) was considered as the presence of distress. In addition, socio-demographic information was assessed. In order to determine predictors factors of DD, the logistic regression analysis was applied.

RESULTS

The mean age (±SD) of the participants was 68.38 (SD:6.78) with the majority being female (53.6%). Among them, 48.6% were identified with DD. A multi-variable logistic regression analysis showed that being female (OR = 1.94, [ 1.30-2.31]), sedentary lifestyle (OR = 3.59, [1.43-9.03]), complications (OR = 3.10, [2.06-4.67]), body mass index (BMI) of 25 or more (OR = 2.46, [1.54-3.94]), duration of disease below 10 years (OR = 2.60, [ 1.56-4.31]), two comorbidity (OR = 2.07, [ 1.19-3.61]) and three or more comorbidity (OR = 3.51, [ 1.20-10.27]) are the predictors of DD.

CONCLUSIONS

DD is notably prevalent among the elderly with T2DM. Attention to psychological aspects of diabetes is a health priority, especially among women and other high-risk groups.

Type 2 Diabetes Mellitus Related Distress in Thailand

This study aimed to investigate prevalence and factors potentially associated with diabetes-related distress (DRD) among type 2 diabetes mellitus (T2DM) patients in a primary health care center in Thailand. This cross-sectional study was conducted with a total of 370 patients with T2DM. Data were collected at primary health care centers in Hang Dong District, Chiang Mai Province, Thailand. DRD was assessed using the Diabetes Distress Scale (DDS-17). The association between sociodemographic characteristics and other factors with DRD was analyzed using the Fisher t-test, Chi-square test, and Pearson's correlation coefficient test. The association between Hemoglobin A1c (HbA1c) and DRD was analyzed using multiple linear regression analysis. The participants had a mean age of 60.95 ± 7.96, and most were female (68.1%). Of the participants with DRD, 8.9% had moderate to high levels of distress. Education level and family support were significantly associated with the overall level of DRD. Additionally, HbA1c and co-morbidity were also significantly associated with DRD, as were emotional burden and regimen distress. Multiple linear regression analysis found that increased HbA1c was positively associated with increased DRD after adjusting for age, sex, education, duration of T2DM, co-morbidity, diabetic complications, and family support. Screening with DRD may be beneficial in T2DM patients.

Diabetes distress, happiness, and its associated factors among type 2 diabetes mellitus patients with different therapies

This study aimed to investigate diabetes distress, happiness, and its associated factors of patients with type 2 diabetes mellitus (T2DM) treated by different therapies, and to analyze the related impact factors. A total of 1512 patients with T2DM were randomly selected from 18 tertiary hospitals in Hunan province from January 2016 to April 2016 who has been treated with oral antidiabetics monotherapy, insulin monotherapy, and combination therapy. Use the general information questionnaire, WHO-5 (the World Health Organization 5 well-being index) and PAID (the problem areas in diabetes scale) to collect the data. There are 846 (55.95%) patients that have serious emotional disorders, and the diabetes related distress in insulin treatment group was higher than that in combination treatment group (P < .05). Happiness of T2DM patients in combination therapy was higher than oral antidiabetic drug monotherapy and insulin monotherapy (P < .05). There was a negative correlation between diabetic suffering and happiness in patients with different treatments (R ranged from -0.335 to -0.436, P < .001). Age and happiness experience could explain 14.8% of the variance. Acute and chronic complications, controlled blood glucose level, lifestyle, therapies, and school education can explain 18.3% variance. Under different therapies, the suffering and happiness of T2DM patients differed from each other. The suffering and happiness of T2DM were related to different therapies, age, complications, glycaemic control, lifestyle, school education, and so on.

Hombres con diabetes mellitus tipo 2: autoeficacia y factores psicológicos que influyen en el autocuidado

Introducción: La prevalencia global de diabetes mellitus tipo 2 (DMT2) en los hombres es alta. Para el tratamiento de la enfermedad el hombre debe realizar acciones de autocuidado, por lo que es importante conocer factores relacionados con su cumplimiento. Objetivo: Identificar la relación entre variables demográficas, clínicas, la angustia, la depresión, la autoeficacia y su influencia sobre el autocuidado en hombres con DMT2. Métodos: Estudio transversal y correlacional, en una muestra de 96 hombres con DMT2, usuarios de 13 centros de salud. Los instrumentos utilizados fueron el cuestionario de acciones de cuidado en diabetes, la escala Self-Efficacy for Diabetes, la escala depresión (CES-D) y la escala angustia por diabetes (DDS). Resultados: El autocuidado se correlacionó de manera positiva con la autoeficacia y negativamente con la angustia por diabetes. Las variables que explicaron el autocuidado con el 47.7% de varianza fueron: la autoeficacia (β = .39), el consumo de alcohol (β = -.29), las horas sentado/parado (β= -.27), el tiempo de diagnóstico (β= -.22) y la edad (β =.18). Discusión: Los hombres tuvieron un bajo autocuidado y mantienen conductas de riesgo, lo cual puede atribuirse a sus creencias, estilo de vida o al tipo de trabajo que desempeñan. Conclusiones: Los resultados ofrecen evidencia sobre factores que influyen en el autocuidado de hombres con DMT2, que pueden orientar a los profesionales de enfermería en la atención del paciente. Se sugiere realizar investigaciones de enfermería en hombres, que contribuyan a mejorar la autoeficacia y el autocuidado.

Diabetes Distress in Young Adults with Type 2 Diabetes: A Cross-Sectional Survey in China

BACKGROUND

Diabetes distress is a negative emotion related to diabetes management, which can compromise self-care and management of diabetes. However, few studies on diabetes distress have focused on young adults with type 2 diabetes in China.

METHODS

A cross-sectional survey was conducted. Using a convenient sampling method, 98 young adults with type 2 diabetes who were admitted to our hospital from June 2017 to July 2018 were selected as research subjects. They were investigated using a basic demographic questionnaire, Diabetes Distress Scale, Summary of Diabetes Self-Care Activities Measure, and Audit of Disease Knowledge. Pearson's correlation analysis and regression analysis were used to analyze the influencing factors of diabetic distress.

RESULTS

Among participants, 90.82% suffered from diabetes distress with an average score of 3.01 ± 0.58. Regimen-related, emotional burden-related, and interpersonal-related distress were the most frequently reported as severe. The results of the single-factor analysis showed that gender (P = 0.019), age (P = 0.003), occupation (P = 0.022), smoking (P < 0.001), and diabetes complications (P = 0.001) were the main factors affecting diabetes distress. The correlation analysis showed that diabetes distress was negatively correlated with the level of diabetic self-management (P < 0.001, r = -0.377) but not with the level of diabetes knowledge (P = 0.052, r = -0.197). The results of a multiple regression analysis showed that self-management level (P = 0.001, 95% CI: -0.039-0.011), age (P = 0.002, 95% CI: -0.463-0.104), smoking (P = 0.018, 95% CI: -0.504-0.048), and complications (P = 0.009, 95% CI: -0.517-0.076) accounted for 35.42% of the total variation in diabetes distress.

CONCLUSION

Young adults with type 2 diabetes reported severe diabetes distress. Age, smoking, and diabetes complications were the main factors influencing diabetes distress in young adults with type 2 diabetes. Results of the present study are fundamental in selecting targeted measures for alleviating diabetes distress and thus improving the quality of life in these patients.

Effect of Educational Strategies on the Sleep Quality of People with Diabetes: Randomized Clinical Trial

Objective: To evaluate the effect of educational strategies on sleep quality and its relation to diabetes-related distress and glycemic control in people with type 2 diabetes mellitus (DM2). Materials and methods: Randomized clinical trial involving two groups. Group 1 (G1, n = 45) received verbal guidance and leaflets on sleep hygiene strategies and group 2 (G2, n = 46) received usual health care guidelines on self-care with the feet. Sleep was assessed by the Pittsburgh Sleep Quality Inventory and diabetes-related distress by the Diabetes Distress Scale. Linear mixed-effects models and linear regression model were used for the statistical analysis. Results: At the end of the follow-up, sleep quality improvement (p = 0.02) was verified in G1. Low diabetes-related distress score (p = 0.03), being male (p = 0.02), belonging to G1 (p = 0.002), and age (p = 0.04) contributed to better sleep quality. Conclusion: Educational guidelines on sleep hygiene in patients with DM2 were effective in improving sleep quality, measured by the PSQI instrument and emotional stress related to diabetes as assessed by the Diabetes Distress Scale.

Diabetes distress and its clinical determinants in patients with type II diabetes

AIM

The present study aimed to determine the status of diabetes distress and its clinical determinants in type II diabetes patients.

METHODS

This descriptive-analytical study was performed on 220 patients with t diabetes referred to Diabetes Clinic of Imam Khomeini Hospital in Ardabil, Iran. The samples were selected using convenience sampling method. Data collection tools included demographic and disease form and Diabetes Mellitus Scale (DDS). Data analysis was performed using SPSS software version 22 via descriptive (frequency, mean, standard deviation) and inferential statistics (compare means, Pearson correlation coefficient and stepwise multiple regression).

RESULTS

The average duration of diabetes was 7.64 (SD = 4.68) years. 63.7% of the patients had moderate to severe diabetes-related distress. Emotional burden dimension had the highest score among the subscales of diabetes distress. In addition, there was a correlation between positive family history (p = 0.017), duration of diabetes (p = 0.028) and type of treatment (p = 0.47) and diabetes distress. HemoglobinA1C levels, body mass index and triglyceride were the major predictors of diabetes distress.

CONCLUSIONS

Considering the high prevalence of diabetes distress in patients with type II diabetes, it seems that paying attention to clinical predictors of distress and screening of patients with diabetes is a reasonable and accessible method for health care providers and patients to improve their disease management.

Adherence to self-monitoring of blood glucose in Chinese patients with type 2 diabetes: current status and influential factors based on electronic questionnaires

BACKGROUND AND PURPOSE

Self-monitoring of blood glucose (SMBG) is important to the management of diabetes mellitus, yet most patients with type 2 diabetes mellitus (T2DM) do not perform SMBG as recommended. The current status and influential factors of SMBG in China have not been well investigated. This study aimed to describe the present status of SMBG adherence in China and investigate the influential factors based on electronic questionnaires.

PATIENTS AND METHODS

A cross-sectional study was conducted from June to July of 2017 at hospitals in Changsha, China. Seven hundred and twenty-one patients with T2DM completed the information‑motivation‑behavioral (IMB) skills questionnaire and other electronic questionnaires composed of demographic and clinical characteristics as well as diabetes-related and psychological scales. Univariate comparisons and multivariate logistic regression were used to explore the relationships among SMBG adherence and related factors.

RESULTS

Seven hundred and twenty-one patients with valid questionnaires were included. Only 27.5% (198/721) of the patients with T2DM were SMBG adherent based on the guideline of the Chinese Diabetes Society (CDS) in 2017. Among all groups of treatment regimens, the rate of SMBG adherence was highest at 36.6% (82/224) in patients on oral hypoglycaemic drugs (OHAs). In multivariable analysis, the treatment of OHAs (OR =3.731, CI 2.162-6.437) and diet/exercise (OR =3.534, CI 1.841-6.783), the patient having their own blood glucose meter (OR =6.916, CI 4.054-11.800) and a higher education level (OR =3.780, CI 1.688-8.466) were significantly associated with SMBG adherence.

CONCLUSION

Most Chinese patients with T2DM did not perform SMBG as recommended. The treatment of OHAs and diet/exercise, the patient having their own blood glucose meter, a higher education level and other factors were correlates of SMBG adherence. There is clearly a need for prospective, multicenter, large-scale studies to explore the reasons for patients' failure to practice SMBG adherence.

Evaluation of the relationship between loneliness and medication adherence in patients with diabetes mellitus: A cross-sectional study

Objective

The emotional status of patients with diabetes mellitus (DM) is important in the course of treatment. The present study aimed to determine the level of loneliness among patients with DM and to evaluate the relationship between the patients’ level of loneliness and medication adherence.

Method

This cross-sectional study used a semi-structured questionnaire and the University of California, Los Angeles Loneliness Scale to collect data from 325 patients who were diagnosed with DM.

Results

We found that loneliness scores were significantly elevated in individuals with a low level of education, unmarried individuals, and students. Furthermore, these scores were elevated in patients diagnosed with type 1 DM, patients on insulin therapy, patients diagnosed with diabetic foot syndrome, patients who did not exercise regularly, and patients who reported being disturbed by reminders from their families or spouses to take their medications or they did not feel anything after such reminders.

Conclusions

Individuals with DM may encounter various problems in their daily lives. Evaluating the emotional status in these individuals, including loneliness and treatment adherence, is important in ensuring that their needs are being met.

Diabetes-Related Distress Assessment among Type 2 Diabetes Patients

BACKGROUND AND OBJECTIVES

Diabetes is one of the most common chronic diseases; it is a debilitating and hard to live with. Diabetes-related distress (DRD) refers to the emotional and behavioral changes caused by diabetes. Our study aims to assess the prevalence of DRD among type 2 diabetes (T2D) patients using Diabetes Distress Scale-17 items (DDS-17) and its relation to complications and treatment modalities.

METHODS

A cross-sectional study of adult T2D patients with follow-up visits at the Diabetes and Endocrinology Center in Taif, Saudi Arabia, between January and July 2017. We excluded patients with other forms of diabetes, untreated hypothyroidism, and psychiatric illness. The total score of DDS-17 was calculated by summing the 17 items' results and then dividing the total by 17. If the total score was >2, then it was considered as clinically significant results (moderate distress), but if it is ≥3, then it is classified as a high distress.

RESULTS

A total of 509 T2D patients with a mean age of 58 ± 14 years were included. The majority of participants were male, married, not college educated, and reported a sedentary lifestyle. We found 25% of the screened T2D patients have moderate to high DRD. Regarding the DRD components, emotional distress was the most prevalent followed by physician-related distress. HabA1c was significantly higher in those with high combined distress and high emotional distress compared to those with mild/moderate distress (p = 0.015 and 0.030, resp.).

CONCLUSION

Our study shows that DRD is a medically relevant issue that clinicians need to address. Despite observing a low prevalence of DRD compared to other studies, we found significant correlations between DRD scores and HabA1c, triglyceride levels, BMI, T2D duration, and interval between visits.

Psychosocial aspects of diabetes management: dilemma of diabetes distress

Diabetes mellitus (DM) is a debilitating chronic illness with complex pathophysiological, psychological, and quality of life (QoL) implications creating a constant state of turbulence. Some of these interconnections are apparent to healthcare providers and are easily addressed in a routine diabetic clinical care. However, a large number of these hidden factors that interplay with each other and impact on the physical outcomes of DM goes unnoticed by health care providers. This is a frustrating and lonely predicament for DM patients making it very difficult for them to manage their illness well. At times these patients are mislabeled as "difficult patients". In other cases they are considered to have and unnecessarily treated for psychiatric illness like depression, other mood or anxiety spectrum disorders which they may not need. In recent years clinical researcher are making strides in understanding the emotional distress a DM patient may feel and the factors contributing or perpetuating diabetes distress. This article focuses on understanding the diabetes distress and how it impacts our patients, how to screen, assess, treat and eventually prevent it from happening. The paper also attempt to bring out the major differences between diabetes distress and common psychiatric comorbidities of DM including but not limiting to major depressive disorder and other depression spectrum disorders.