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

Early onset type 2 diabetes mellitus: an update

The incidence and prevalence of type 2 diabetes mellitus (T2DM) in young individuals (aged <40 years) have significantly increased in recent years, approximating two to threefold increase in the respective rates. Numerous risk factors including severe obesity, family history, ethnicity, maternal diabetes or gestational diabetes, and female sex contribute to a younger age of onset. In terms of pathogenesis, impaired insulin secretion is the key operating mechanism, alongside with ectopic adiposity-related insulin resistance. T2DM diagnosis in a young adult requires the exclusion of type 1 diabetes mellitus (T1DM), latent autoimmune diabetes of adults (LADA) and maturity-onset diabetes of the young (MODY). The establishment of such diagnosis is critical for prognosis, because early-onset T2DM is associated with rapid deterioration in pancreatic β-cell secretory function leading to earlier initiation of insulin therapy. Furthermore, mortality and lifetime risk of developing complications, especially microvascular, is increased in these patients compared to both later-onset T2DM and T1DM patients; also, the latter are often developed earlier in the course of disease. The management of early-onset T2DM follows the same guidelines as in later-onset T2DM; yet patients aged 18-39 years are underrepresented in the big clinical trials on which the development of guidelines is based. Finally, young people with T2DM face significant challenges associated with social determinants, which compromise their adherence to therapy and induce diabetes distress. Future research focusing on the pathogenesis of β-cell decline and complications, as well as on specific treatment shall lead to better understanding and management of early-onset T2DM.

Simultaneous induction of systemic hyperglycaemia and stress impairs brain redox homeostasis in the adult zebrafish

For diabetic patients it is crucial to constantly monitor blood glucose levels to mitigate complications due to hyperglycaemia, including neurological issues and cognitive impairments. This activity leads to psychological stress, called "diabetes distress," a problem for most patients living with diabetes. Diabetes distress can exacerbate the hyperglycaemia effects on brain and negatively impact the quality of life, but the underlying mechanisms remain poorly explored. We simulated diabetes distress in adult zebrafish by modelling hyperglycaemia, through exposure to dextrose solution, along with chronic unpredictable mild stress (CUMS), and evaluated brain redox homeostasis by assessing reactive oxygen species (ROS) content, the antioxidant system, and effects on mitochondrial biogenesis and fission/fusion processes. We also evaluated the total, cytosolic and nuclear content of nuclear factor erythroid 2-related factor 2 (NRF2), a critical regulator of redox balance, in the whole brain and total NRF2 in specific brain emotional areas. The combined CUMS + Dextrose challenge, but not the individual treatments, reduced total NRF2 levels in the entire brain, but strongly increased its levels in the nuclear fraction. Compensatory upregulation of antioxidant genes appeared inadequate to combat elevated levels of ROS, leading to lowering of the reduced glutathione content and total antioxidant capacity. CUMS + Dextrose treatment also upregulated transcription factors implicated in mitochondrial biogenesis and dynamics with a predominance of fission, which is consistent with increased oxidative stress. In conclusion, this study highlights the close interplay between hyperglycaemia and psychological distress causing overriding oxidative stress in the brain, rendering the organism vulnerable to the development of disease complications.

A diabétesz okozta distressz és az életminőség összefüggései 2-es típusú cukorbetegséggel élők körében – szisztematikus irodalmi áttekintés

Háttér: Cukorbetegséggel élni megterhelő. Ezért, nem meglepő módon, ez a betegség nagyon gyakran érzelmi distresszt okoz, amelyet betegségre specifikusan diabétesz okozta distressznek hívunk. A cukorbetegséggel élők esetében a negatív érzelmi tünetek azonban nemcsak a pszichés jóllétre hatnak negatívan, hanem a magasabb distresszt megélő betegek alacsonyabb adherenciával jellemezhetőek, rosszabb glikémiás kontrollal rendelkeznek, és körükben magasabb a mortalitás is. A krónikus betegségek, így a cukorbetegség is nagymértékben rontja a szubjektív életminőséget, ráadásul a vonatkozó kutatások eredményei alapján a diabétesz okozta magasabb distressz rosszabb észlelt életminőséggel is együtt jár, és e két tényező külön-külön is, de együttesen is prediktora egyéb, a cukorbetegség önmenedzselésével kapcsolatos változóknak, mint amilyen például a glikémiás kontroll vagy az adherencia. Célkitűzés: Azonosítani néhány tényezőt és rizikófaktort amelyek a 2-es típusú cukorbetegséggel élő felnőttek körében befolyásolják a diabétesz okozta distresszt és az életminőséget. Módszerek: Tanulmányunkat a szisztematikus irodalomkutatás módszerével készítettük, angol nyelvű cikkeket keresve az EBSCO és az Embase adatbázisokban. Eredmények: A diabétesz distresszt és a betegséggel kapcsolatos életminőséget befolyásoló tényezők és rizikófaktorok egy része az ismertetett kutatások alapján beazonosítható, és általuk pontosabban meghatározhatók olyan beavatkozási pontok, amelyekkel a diabétesszel összefüggő distressz és annak következményei eredményesen csökkenthetőek.

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.

Diabetes Distress Among the Roma Population From a Tertiary Care Center in Romania

Background Distress in patients with diabetes is a condition that has received significant attention in recent years; however, data regarding the psychological assessment and the impact of the emotional burden of diabetes among the Roma population are still scarce in the medical literature. Material and methods We conducted an observational, transversal study that included 310 adult patients with diabetes mellitus, aged between 18 and 85 years old, of which the majority (61%) were women; patients were selected from a tertiary hospital providing diabetes care; diabetes distress was evaluated using a standardized questionnaire, the diabetes distress scale (DDS), validated on Romanian patients. Results In the study population, a great proportion of patients showed diabetes distress, with 24.8% (N=82) having moderate distress and 29.7% (N=121) having severe distress. In the Caucasian group, there were significantly more patients without distress than in the Roma patients,while on the contrary, more Roma patients experienced severe distress compared to the opposite group (64.5%, N=78 versus 35.5%, N=43). In the Caucasian group, a statistical significance was observed regarding interpersonal distress, with Caucasian women having a higher score than men. Concerning the Roma patients, total DDS and all subscales´ scores were statistically significant, with Roma women having higher scores than men. A statistical significance was observed between ethnicity and diabetes distress scores, with the Roma population having higher median values than Caucasian patients. It was also demonstrated that the lack of education, a higher diabetes evolution, and a higher glycated hemoglobin (HbA1c) level (above 8%) have influenced the risk of severe DDS in the Caucasian group, while in the Roma patients, employment status (being unemployed) represents a risk factor for severe DDS. Conclusion The Roma patients included in our study experienced higher distress scores compared to Caucasians. These results are substantial as they emphasize the need to include the evaluation of diabetes distress in clinical practice to facilitate the early initiation of intervention measures. There is nevertheless limited data regarding this particular ethnic group; therefore, further research is still needed.

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.

Understanding the Dynamic Relationship of Diabetes Distress and Glycemic Indicators in Foot Ulcer Patients: A Correlative Study

BACKGROUND

Diabetes-related distress and glycemic indicators are the most common concerns for patients with diabetes mellitus and have a major impact on diabetic patients' lifestyle, mental well-being, and healthcare access. The principal aim of research in this field is to ascertain the correlation between distress associated with diabetes and glycemic indicators. this helps in developing interventions that can enhance the overall physical and mental well-being of individuals with diabetes.

OBJECTIVE

The objective is to assess the diabetes distress and glycemic indicators among patients with foot ulcers and to find the correlation between diabetes distress and glycemic parameters.

MATERIALS AND METHODS

A descriptive correlational study was conducted among 159 patients with foot ulcers who were admitted to the hospital by using a non-probability purposive sampling method. The severity of diabetes distress was evaluated utilizing the four-subscale Diabetes Distress Scale (DDS-17). Glycemic indicators are calculated through the assessment of random blood sugar, fasting blood sugar (FBS), and glycosylated hemoglobin (HbA1c).

RESULT

The study revealed that most participants were above 60 years old and were male. Of the samples, 52% had moderate distress. All the subscales of diabetes distress are correlated to the overall DDS score. A negative correlation (r= -0.162, p < 0.041) was found between emotional burden and FBS which was statistically significant, whereas FBS is positively related to HbA1c (r=0.194, p=0.015).

CONCLUSION

 The significant correlation between DDS scores, the subscales of diabetes distress, and glycemic indicators highlights the criticality of incorporating diabetes distress management into comprehensive strategies for managing diabetes. Moreover, the research underscores the necessity of employing multidisciplinary strategies when attending to diabetic patients to prevent complications.

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.

Diabetes Distress and Illness Perceptions in Tunisian Type 2 Diabetes Patients

Purpose

Diabetes distress (DD) refers to the negative emotions and burden of living with diabetes. Illness perceptions are among the factors that can influence self-management and psychological distress in diabetics. This study aimed to determine the prevalence and the associated factors of DD in Tunisian patients with type 2 diabetes mellitus. We also studied the relationship between DD and illness perceptions in diabetics.

Patients and Methods

This was a cross-sectional study conducted among individuals with type 2 diabetes, followed up at the outpatient endocrinology unit at the Hedi Chaker University Hospital, Tunisia. DD was assessed using the Diabetes Distress Scale (DDS-17). The Brief Illness Perception Questionnaire (Brief-IPQ) was used to assess diabetes illness perceptions. Multivariate logistic regression was used to determine independent factors associated with the presence of DD.

Results

A total of 103 patients were recruited. The mean age was 59.31 (±10.83) years; 54.4% were female. In total, 70.9% had DD. Using regression analysis, we demonstrated that the illness perceptions of personal control, HbA1C, absence of comorbidities, lower age at diabetes diagnosis, and socioeconomic status were significantly associated with DD.

Conclusion

This study sheds light on the high prevalence of DD among patients with type 2 diabetes in Tunisia. Illness perception-focused psychological intervention would be efficacious in reducing diabetes distress in patients with type 2 diabetes mellitus.

Diabetes Distress Among Type 1 Diabetic Adolescents in a Tertiary Care Hospital in Pakistan

BACKGROUND AND AIM

 Diabetes distress, a term used to describe negative emotions associated with diabetes, is the key factor responsible for the elevated risk of psychological burden and compromised self-management. The aim of this study is to determine the prevalence of diabetes-related distress among adolescent patients with type 1 diabetes (T1D) and to ascertain various factors associated with it.

METHODOLOGY

In this cross-sectional study, 117 T1D patients with age 12-20 years visiting a diabetic clinic in the Department of Endocrinology and Metabolism, Services Hospital Lahore from February 2022 to August 2022 were enrolled. The patient's demographic and clinical details were noted in a pre-designed proforma. T1D distress scale (T1DDS) was utilized as the tool for measuring diabetes distress and distress was classified as severe, moderate, and no/little distress.

RESULTS

Of the total 117 T1D patients, 34.2% (n=40) had diabetes-related distress, out of which 31.6% had moderate and 2.6% had severe distress. The average total distress score was 1.73 ± 0.52 and higher mean scores were of powerlessness, negative social perception, and eating distress. Distress was higher among females, in those with the onset of diabetes in teens rather than in childhood. There is a significant impact of glycated hemoglobin (HbA1c) on the severity of diabetes distress as demonstrated by Pearson's correlation (r=.570, n= 117, p = <.001) Conclusion: The present study highlights the association of diabetes distress in adolescents with various factors, most significantly poor glycemic control, and therefore emphasizes the need for developing psychological interventional strategies in routine diabetes care to improve the mental well-being and self-management of diabetic patients.

Relation between diabetes related distress and glycemic control: The mediating effect of adherence to treatment

AIMS

Diabetes related distress (DRD) is a negative emotional reaction to stresses associated with diabetes mellitus (DM) and its management. This study estimated the burden of DRD and self-reported adherence to treatment (SRAT) among patients with DM and investigated their relationship with glycemic control.

METHODS

A cross sectional study of consented 157 diabetics was conducted using the17-item Diabetes Distress Scale (DDS). It measures distress at four subscales: Emotional Burden (EB), Physician-related (PD), Regimen-related (RD) and Interpersonal Distress (ID). SRAT was assessed using Morisky's scale. Glycemic control was assessed using the most recent HbA1c results. Multivariable linear regression analysis was used for adjustment of confounders and bootstrap Confidence Interval was used to test for the occurrence of mediating effect.

RESULTS

Average age was 44.5 ± 16.0 years, 65% were females, 79% had type 2 DM and nearly 55% has had DM for more than 7 years and the average HbA1c was 8.9 ± 2.2%. Clinically significant DRD was reported by 37% of the participants, EB and RD in 40.8%, PD in 46.5%, and ID among 32.5%. Younger patients showed higher level of stress compared to older participants and patients with type 1 DM showed higher level of stress in all DRD domains. Only 46% of patients were defined as having satisfactory SRAT and improvement of SRAT significantly enhanced the glycemic control (r = -0.32, p < 0.01). DRD and low SRAT negatively correlated with HbA1c; increasing the DRD by one point may increase the HbA1c on average by 0.41 (C.I. 0.02-0.80) and will indirectly raise the HbA1c by 0.24 (C.I. 0.04-0.47) through the mediating effect of low SRAT.

CONCLUSION

DRD and low SRAT are commonly reported among DM patients and both are indirectly correlated. The mediating effect of low SRAT highlights the clinical role of DRD and clarifies the process by which distress affect the outcome of DM management.

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.