Clinical and sociodemographic variables associated with diabetes-related distress in patients with type 2 diabetes mellitus

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.

The mediating role of quality of life on depression and medication adherence among patients with type 2 diabetes mellitus: A cross-sectional study

Background and Aim

Patients living with diabetes mellitus have a high burden of psychological distress such as depression and anxiety as well as impaired quality of life, which may negatively impact their adherence to medications, glucose control, and health-related costs.This study assessed the impact of quality of life and depression on medication adherence among patients with type 2 diabetes (type 2 diabetes mellitus [T2DM]) in a tertiary care setting in Ghana.

Methods

The study was a cross-sectional study involving 238 patients with diabetes aged 18 years and above. Validated tools were used to assess medication adherence, depressive symptoms, and quality of life. Structural Equation Modeling was adopted to examine the mediation effect of quality of life on the relationship between depression and medication adherence among participants.

Results

The mean age of the participants was 58.82 ± 13.49, and 169 (71.0%) out of a total of 238 respondents were females. Depression had a significant direct relationship with the quality of life of respondents [aβ (95% confidence interval, CI) = -0.20 (-0.03, -0.00), p < 0.05; -0.21 (-0.41, -0.01) p < 0.05, respectively] and indirect relationship with quality of life [aβ (95% CI) = -0.01 (-0.02, -0.004) p < 0.001]. Educational status and religion both showed a significant indirect relationship with quality of life [aβ (95% CI) = 0.06 (0.07, 0.12), p < 0.05; 0.18 (0.01, 0.35) p < 0.05, respectively]. The mediating effect of quality of life on the relationship between depression and medication adherence was significant (Sobel = -3.19, p < 0.001).

Conclusion

Depression, medication adherence, and quality of life were higher among older adults with T2DM. Depression was also found to have a strong negative association with both medication adherence and quality of life. Interventions to screen for depression and to improve the quality of life in patients living with diabetes are also recommended and this should go beyond the provision of standard treatments to explore further the mechanisms of this relationships.

Diabetes distress in a Medicaid sample: The role of psychosocial and health-related factors

AIMS

Diabetes-related distress can negatively affect disease management leading to worse complications, especially among marginalized populations. Prior studies mostly focus on distress' impact on diabetes outcomes, with few examining distress predictors. The current study examined the impact of social needs on distress on its own and after controlling for other socio-demographic, psychosocial, and health factors.

METHODS

Adult Medicaid beneficiaries with type 2 diabetes and a recent HbA1c test documented in claims data (<120 days) were recruited for a 12-month social needs intervention trial. Baseline survey data assessed diabetes distress, social needs, psychosocial factors and health factors. Descriptive statistics were obtained, and bivariate and multivariable logistic regression analyses were used to identify predictors of moderate to severe distress.

RESULTS

Bivariate analyses revealed social needs, stress, depression, comorbidity and comorbidity burden, poor self-rated health, insulin use, a self-reported HbA1c ≥ 9.0, and difficulty remembering to take diabetes medications were all positively associated with greater odds of diabetes distress; greater social support, diabetes self-efficacy, and age were negatively associated. Four variables remained significant in the multivariate model: depression, diabetes self-efficacy, self-reported HbA1c ≥ 9.0, and younger age.

CONCLUSIONS

Targeted distress screening efforts might prioritize people with HbA1c values >9.0, greater depression, and worse diabetes self-efficacy.

Diabetes Distress Among Adults With Type 1 Diabetes Mellitus in Saudi Arabia

Background Psychological morbidity is clinically important for diabetes patients because it is often associated with worse glycemic outcomes. This study aimed to assess the prevalence of diabetes distress among adult type 1 diabetes mellitus (DM) patients in the Kingdom of Saudi Arabia (KSA). Methodology A descriptive, cross-sectional study was conducted among type 1 DM patients in KSA from 2021 to 2022. An online validated questionnaire was adopted to collect data, including demographic information, medical and social information, and Saudi Arabian Diabetes Distress Scale-17 (SADDS-17) score to assess diabetes distress. Results This study included 356 type 1 DM patients. Most patients were females (74%), with ages ranging between 14 and 62 years. More than half (53%) had a high level of diabetes distress with a mean score of 3.1 ± 1.23. Among those patients, the highest score (up to 60%) was related to regimen-related distress, the lowest score (around 42%) was related to diabetes-related interpersonal distress, and physician-related distress and emotional burden were reported among 55% and 51%, respectively. More than half (56%) of the patients treated with an insulin pen compared to 43% treated with an insulin pump had high diabetes distress (p = 0.049). The level of HbA1c was significantly higher among patients with high diabetic distress (7.93 ± 1.72 vs. 7.55 ± 1.65; p = 0.038). Conclusions Diabetes distress is prevalent among adult type 1 DM patients in KSA. Therefore, we recommend organizing a screening program for early discovery and prompt psychiatric management, incorporating diabetes education and nutrition consultation to improve their quality of life, and engaging patients in their own management to improve their glycemic control.

Sociodemographic and Diabetes-related Risk Factors in San Diego County, California

BACKGROUND

The research information would enable clinicians and public health professionals to formulate proper interventions for diabetic people according to age, gender, and race.

OBJECTIVE

The aim of the study was to investigate the relationship between diabetes-related mortality, hospitalization and emergency department discharge, and sociodemographic characteristics, in addition to age-standardized mortality rate analysis.

METHOD

A population-based cross-sectional descriptive study was carried out to determine the relationship between sociodemographic characteristics and diabetes-related risk factors of the San Diego County residents in 2018, including 49,283 individuals (27,366 males and 21,917 females).

RESULTS

The outcomes were found to be statistically significant. Hospitalization and emergency department discharges among males and females were statistically significant. The statistical differences between gender and mortality were not significant. The mortality was not significant in the male group, while it was statistically significant in the female group. The noted agestandardized mortality rate of diabetes stood at 85.8 deaths per 100,000 standard population.

CONCLUSION

This study found that mortality increases as people age, and 85% of deaths were found to be of people older than 65 years. The mortality was two times higher among white and Hispanic males than females. Findings from this study are important in understanding the sociodemographic characteristics at the county level, which can inform diabetes mortality prevention efforts.

Psychometric validation of diabetes distress scale in Bangladeshi population

Diabetes Distress (DD)-an emotional or affective state arise from challenge of living with diabetes and the burden of self-care-negatively impact diabetes management and quality of life of T2DM patients. Early detection and management of DD is key to efficient T2DM management. The study aimed at developing a valid and reliable instrument for Bangladeshi patients as unavailability such a tool posing challenge in diabetes care. Linguistically adapted, widely used, 17-item Diabetes Distress Scale (DDS), developed through forward-backward translation from English to Bengali, was administered on 1184 T2DM patients, from four diabetes hospitals in Bangladesh. Psychometric assessment of the instrument included, construct validity using principal component factor analysis, internal consistency using Cronbach's α and discriminative validity through independent t-test and test-retest reliability using intraclass-correlation coefficient (ICC) and Kappa statistics. Factor analysis extracted 4 components similar to original DDS domains, confirms the construct validity. The scale demonstrated satisfactory internal consistency (α = 0.838), stability (test-retest ICC = 0.941) and good agreement across repeated measurements (Kappa = 0.584). Discriminative validity revealed that patients with complication (p < 0.001) and those are on insulin (p < 0.001) had significantly higher distress scores in all domains. Bengali version of DDS is a valid and reliable tool for assessing distress among Bangladeshi T2DM patients.

Diabetic Distress Among Diabetic Patients in the Amhara Regional State, Ethiopia

Diabetes distress is a psychological reaction to the threat of diabetes, when an individuals diagnosed with diabetes consider the coping resources they possess as insufficient to manage the illness threat, thus triggering emotional distress specific to diabetes. Research conducted in Ethiopia regarding diabetes-related distress is scant. The main purpose of this study was to assess the status of diabetic distress among diabetic patients in the hospitals of the Amhara Region. A hospital-based cross-sectional survey research approach was employed. A total of 14 hospitals was included in the study using stratified simple random sample methods. The participans of the study were 532 diabetic patients who were selected using systematic simple random sampling methods. The pertinent data were collected using diabetic distress scale-17 (DDS-17). The instrument of the study was rated, piloted, and finally validated. Both descriptive and inferential techniques were used to analyze the data. The cutoff for low, moderate, and high distress level was <2, 2-2.9, and >3, respectively. The study revealed that the participant in the study area experienced a moderate level of distress. The status of diabetic distress for the diabetic sub-scale was also determined for emotional burden, physician-related distress, regimen-related distress, and interpersonal distress, it was also found to be (2.79 ± 0.85), (3.14 ± 0.87), (3.19 ± 0.81), and (3.04 ± 0.93) respectively. The most important domain in measuring diabetic distress was regimen-related distress. Statistically, a significant difference was detected in the level of diabetic distress among diabetic patients concerning marital status, educational status, the experience of living with diabetes, and having habits of planned physical exercise. Statistically, a significant difference was not observed for age, sex, and occupational status. Diabetic distress was a solemn psychological problem among diabetic patients in the hospitals of the Amhara Region. A strong policy document is required to bind the physical treatment with psychological elements to reduce distress.

Patient-reported outcomes for diabetes and hypertension care in low- and middle-income countries: A scoping review

INTRODUCTION

Patient-reported outcome measures (PROMs) assess patients' perspectives on their health status, providing opportunities to improve the quality of care. While PROMs are increasingly used in high-income settings, limited data are available on PROMs use for diabetes and hypertension in low-and middle-income countries (LMICs). This scoping review aimed to determine how PROMs are employed for diabetes and hypertension care in LMICs.

METHODS

We searched PubMed, EMBASE, and ClinicalTrials.gov for English-language studies published between August 2009 and August 2019 that measured at least one PROM related to diabetes or hypertension in LMICs. Full texts of included studies were examined to assess study characteristics, target population, outcome focus, PROMs used, and methods for data collection and reporting.

RESULTS

Sixty-eight studies met the inclusion criteria and reported on PROMs for people diagnosed with hypertension and/or diabetes and receiving care in health facilities. Thirty-nine (57%) reported on upper-middle-income countries, 19 (28%) reported on lower-middle-income countries, 4 (6%) reported on low-income countries, and 6 (9%) were multi-country. Most focused on diabetes (60/68, 88%), while 4 studies focused on hypertension and 4 focused on diabetes/hypertension comorbidity. Outcomes of interest varied; most common were glycemic or blood pressure control (38), health literacy and treatment adherence (27), and acute complications (22). Collectively the studies deployed 55 unique tools to measure patient outcomes. Most common were the Morisky Medication Adherence Scale (7) and EuroQoL-5D-3L (7).

CONCLUSION

PROMs are deployed in LMICs around the world, with greatest reported use in LMICs with an upper-middle-income classification. Diabetes PROMs were more widely deployed in LMICs than hypertension PROMs, suggesting an opportunity to adapt PROMs for hypertension. Future research focusing on standardization and simplification could improve future comparability and adaptability across LMIC contexts. Incorporation into national health information systems would best establish PROMs as a means to reveal the effectiveness of person-centered diabetes and hypertension care.

Diabetes Distress and Associated Factors in Patients with Diabetes Mellitus in South East Nigeria

<b><i>Background:</i></b> Diabetes distress (DD) is a common worldwide problem in diabetic patients irrespective of age and type of treatment. In the DAWN 2 study (Diabetes Attitudes, Wishes, and Needs), DD was reported by 44.6% of participants. <b><i>Objectives:</i></b> The purpose of this study was to assess the prevalence and level of DD and its associated factors among adult diabetic patients in South East Nigeria. <b><i>Methods:</i></b> The present study was cross-sectional and descriptive. Patients attending the adult diabetes clinic were enrolled. The questionnaire was administered by the investigators. All patients were eligible. Their demographic and clinical data were obtained. They were screened for DD using the DD Scale (DDS)-2 and DDS-17. Data were tabulated and analyzed using SPSS version 21. <b><i>Results:</i></b> There were 110 subjects (38 males and 72 females), aged 36–85 years (60.5 ± 10.0). Only 9 (8.2%) had diabetes mellitus (DM) type 1, while the rest had type 2 DM. Twenty-five subjects (22.7%) were on insulin injection. Hypertension was coexistent in 72%, and they were prescribed 3–10 medications (5.9 ± 1.5) at the time of assessment. The male and female subjects were comparable. Moderate to severe DD was present in 51.9% (DDS-17). The average scores were for DDS-2, 3.1; DDS-17, 2.3; emotional burden, 2.9; physician-related distress, 1.4; regimen-related distress, 2.5, and interpersonal distress, 2.2. Distress was significantly associated with a younger age, T1DM, longer duration of diabetes, use of insulin injection, and HbA_1C level. <b><i>Conclusion:</i></b> DD is a common consequence of living with diabetes and impairs diabetes self-care behavior and glycemic control. Active screening for DD should be an integral part of diabetes care. Diabetes self-management education and support should be implemented at diagnosis and as needed thereafter, especially when DD is diagnosed.

Perceptions of healthcare professionals and people with type 2 diabetes on emotional support: a qualitative study

Background

Type 2 diabetes mellitus (T2DM) is a demanding condition that impacts the person living with the condition physically and psychologically. Promoting emotional support is a key strategy to improve diabetes care.

Aim

To explore the views and experiences of people with T2DM and healthcare professionals (HCPs) on emotional support in diabetes care, and identify barriers and facilitators to the provision of emotional support in clinical practice.

Design & setting

A qualitative study in England with data collected from four focus groups.

Method

Focus group discussions were conducted with people with T2DM (n = 10) and HCPs (n = 10). The analysis was informed by the framework method and principles of the constant comparative approach.

Results

Emotional support was lacking in diabetes primary care, and there was a need to normalise the emotional impact of T2DM. Barriers to emotional support included: lack of HCP confidence to discuss emotional issues; lack of counselling training; and time constraints in consultations. Inappropriate use of the word ‘depression’ creates a sense of taboo for those experiencing emotions other than depression.

Conclusion

Consensus between the two target groups indicated a strong need to integrate emotional support in diabetes care, and the need to support and train HCPs in addressing psychosocial aspects of T2DM. Shared language is recommended across diabetes services to appropriately refer to wellbeing. Addressing barriers and considering ways to incorporate emotional management in diabetes consultations is recommended, includings introducing HCP training to increase confidence and enhance counselling skills.

Frequência de sofrimento emocional é elevada em pessoas com diabetes assistidas na atenção primária

Introdução: Pessoas com diabetes podem sofrer com o estresse da doença e apresentar sentimentos como culpa, raiva, medo e depressão, que caracterizam o Sofrimento Emocional Específico da Diabetes. Objetivo: estimar a frequência desse sofrimento e seus fatores associados em pessoas assistidas na atenção primária em Blumenau, Santa Catarina. Métodos: Trata-se de estudo transversal. Pessoas com diabetes assistidas por 4 equipes de saúde da família (n=196) responderam ao questionário “Problems Areas in Diabetes”, que apresenta 20 questões em 4 subdimensões, além de questões sobre suas características sociodemográficas (sexo, idade, escolaridade) e clínicas (tempo de doença, uso de insulina e medicação antidepressiva). Estimou-se os escores de sofrimento geral e subdimensões com base na soma das respostas em escala de 0 (melhor) a 100 (pior). Mediu-se a frequência do sofrimento emocional grave (escore >40) e sua associação com as variáveis de estudo por regressão logística não condicional. Resultados: Participaram 196 pessoas, 58,2% eram mulheres, 26,2% faziam uso de insulina e 20,6% de antidepressivos. A idade média foi de 61,6 anos, o tempo médio de tratamento de diabetes foi 9,5 anos. O escore médio de sofrimento emocional foi de 33,6 (dp=27,6) e mediana de 23,8. 36,2% dos participantes apresentaram sofrimento emocional grave. O sofrimento emocional grave se mostrou principalmente entre pessoas com 19 a 64 anos (OR=2,1, IC95%1,1 - 4,1), com tempo de doença de 2 a 5 anos (OR=6,4; IC95% 1,1 - 36,1) e 5 anos e mais (OR=5,4; IC95% 1,1 - 28,8) e em uso de medicação antidepressiva (OR=2,8 IC95% 1,3 - 6,0). Conclusão: Mais de um terço das pessoas com diabetes tem sofrimento emocional grave, marcadamente os adultos com mais tempo de doença e com tratamento para depressão. Sugere-se que essas pessoas tenham seu cuidado priorizado pelas equipes de saúde na atenção primária.

Characterizing Hotspots and Frontier Landscapes of Diabetes-Specific Distress from 2000 to 2018: A Bibliometric Study

Objectives

This work aims to comprehensively characterize hotspots and frontier landscapes concerning diabetes-specific distress from 2000 to 2018.

Materials and Methods

Firstly, diabetes-specific distress-related literature was retrieved and downloaded from the Web of Science Core Collection (WoSCC). Secondly, WoSCC self-contained toolkits and GraphPad Prism7 were conducted to analyze general characteristics, including literature products, countries, institutes, authors, and journal resource. Finally, CiteSpace V Toolkits was put forward to implement advanced analysis, consisting of keyword-term frequency and co-occurrence, references-cited frequency and co-occurrence, and burst detection for keyword terms and references cited, which uncovers the hotspots and frontiers of diabetes-specific distress.

Results

After preprocessing, our study included a total of 1051 papers concerning diabetes-specific distress. Publication outputs increased smoothly year by year. Compared with other journals, diabetic medicine delivered the largest number of documents. The United States occupied the leading positions, and the most productive institution was the University of California System in terms of literature products. Fisher L. has the highest references-cited frequency. Prevalence of diabetes-specific distress, diabetes-specific distress and glycemic control, diabetes-specific distress and depression comorbidity, and diabetes-specific distress and risk factors were the research hotspots, whereas the measure of diabetes-specific distress and latent and serious/severe diabetes-specific distress was the research frontiers.

Conclusions

Overall, our study may inspire researchers to show great interest in diabetes-specific distress in the next few years.

Wondim M. Diabetic Distress Among Diabetic Patients in the Referral Hospital of Amhara Regional State, Ethiopia

The main purpose of this study was to assess the status of diabetic distress among diabetic patients of referral hospitals in Amhara Regional State. Hospital-based cross-sectional survey was conducted on 346 participants. The participants of the study were selected using both probability and nonprobability sampling techniques. The instrument of the study was adapted and contextualized to the Ethiopian context to avoid cultural conflicts, and then it was rated and piloted. Both descriptive and inferential techniques were used to analyze the data. The cut-off for low, moderate, and high distress level was <2, 2–2.9, and ≥3, respectively. From a total of 346 sample patients, 54 (15.6%) had experienced no or little distress (1.54 ± .28), 162 (46.8%) had moderate distress (2.78 ± .82), and 130 (37.6%) had experienced high distress (3.94 ± .62). Statistically significant difference was observed in the level of diabetic distress with respect to age, F(2, 343) = 4.336, p < .05; marital status, F(2, 343) = 4.590, p < .05; educational status, F(5, 340) = 2.831, p < .05; and having habits of planned physical exercise, F(3, 245) = 2.911, p < .05. Statistically significant difference was not observed for sex, smoking habits, an experience of living with diabetics, and occupational status. The result of regression analysis shows that the independent variable altogether accounted for only 4.2% of the variance of diabetic distress. Diabetic distress was a serious psychological problem among diabetic patients in the referral hospitals of Amhara Region.

Distress and psychopathology among Sudanese patients with type 2 diabetes mellitus and its relation to glycaemic control

Objectives

Methods

Results

Conclusion