Diabetes Distress and Glycemic Control in Type 2 Diabetes: Mediator and Moderator Analysis of a Peer Support Intervention

Psychological distress and its impact on glycemic control in patients with diabetes, Northwest Ethiopia

Background

Diabetes distress is the emotional and mental burden of living with diabetes. It can include feelings of frustration, guilt, anxiety, and worry. Understanding the factors contributing to psychological distress and how it affects glycemic control can be crucial for improving patient outcomes. Therefore, this study investigated the association between psychological distress levels and glycemic control in patients with diabetes. It also identified factors associated with severity of psychological distress.

Methods

A multicentre cross-sectional study was conducted among patients with diabetes at selected hospitals in Northwest Ethiopia. Psychological risk distress was measured using the Kessler 10 (K10) questionnaire, validated for this population. Glycemic control was categorized as poor and good based on patients' current glucose records and following recommended guidelines. Logistic regression examined the association between psychological distress levels and glycemic control. Linear regression assessed the association between psychological distress score and other independent variables. p-value <0.05 was considered statistically significant.

Results

More than half (218, 54.2%) of the participants had severe psychological distress with a 27.4 (±4.6) mean score. Patients with moderate [AOR = 1. 85, 95% CI: 1.05-3.76] and severe [AOR = 2.84, 95% CI: 1.32-7.31] distress levels significantly had poor glycemic control compared to those with no distress. BMI [β = 0.61, 95% CI: 0.42, 71], monthly salary [β = -0.41, 95% CI: -67, -0.25], source of healthcare cost [β = -0.75, 95% CI: -2.36, -0.03], SMBG practicing [β = -0.85, 95% CI: -1.93, -0.25], lifestyle modifications [β = -1.66, 95% CI: -3.21, -0.18], number of medical conditions [β = 0.72, 95% CI: 0.57, 2.81], number of medications [β = 2.26, 95% CI: 1.05, 4.57], hypoglycaemia perception [β = 2.91, 95% CI: 1.32, 7.01], and comorbidity and/or complications [β = 3.93, 95% CI: 1.08, 6.72] were significantly associated with severity of psychological distress.

Conclusion

Most patients reported having moderate to severe psychological distress, which in turn, negatively impacted their glycemic control. Interventions incorporating mental health and psychosocial support should be implemented to relieve psychological distress and improve glycemic control.

Diabetes Distress Among US Adults With Diagnosed Diabetes, 2021

National prevalence of diabetes distress is unknown among US adults. This cross-sectional study examined the prevalence among US adults with diabetes using 2021 National Health Interview Survey data. Multivariable multinomial logistic regressions were used to estimate adjusted prevalence and prevalence ratios for diabetes distress. Adjusted prevalence of moderate and severe diabetes distress was 24.3% (95% CI, 22.5%-26.1%) and 6.6% (95% CI, 5.6%-7.8%), respectively. Prevalence was higher among people aged 18 to 64 years, women, and those with lower incomes. Findings highlight the importance of examining economic and social factors and integrating diabetes distress screening into diabetes management and services.

Diabetes distress profiles and health outcomes of individuals with type 2 diabetes and overweight/obesity: A cluster analysis

AIMS

To determine the prevalence and patterns of diabetes distress, and evaluate the differences in health outcomes between profiles.

METHODS

This cross-sectional study included 330 adults with T2DM and overweight/obesity. The participants completed questionnaires on diabetes distress, sleep quality, self-efficacy, depression, anxiety and positive and negative affect. A cluster analysis was performed to identify different patterns of diabetes distress and one-way ANOVA was used to investigate the differences in physical and psychological outcomes between profiles.

RESULTS

30.6% of patients were identified as moderately to highly distressed, with the regimen-related distress found to be the most prominent. The Cluster analysis revealed four distinct clusters: (1) "comprehensively exhausted profile"; (2) "strained profile"; (3) "high internal anguish profile"; (4) "unperturbed profile". The measures of fasting blood glucose (FBG), glycated hemoglobin (HbA1c), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, sleep quality, depression, anxiety, positive and negative affect and self-efficacy differ between clusters.

CONCLUSIONS

This study identified important differences that existed in patterns of diabetes distress among people with T2DM and overweight/obesity, and this variation can be utilized to tailor intervention strategies to the particular needs of different subgroups within individuals with T2DM.

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.

COVID-19 pandemic-related healthcare interruptions and diabetes distress: a national study of US adults with diabetes

BACKGROUND

Early COVID-19 pandemic research found changes in health care and diabetes management, as well as increased diabetes distress. This study aims to determine the association between COVID-19 pandemic-related healthcare interruptions and diabetes distress among adults with Type 1 and Type 2 diabetes in the US in 2021.

METHODS

Multinomial logistic regression was used to analyze moderate and high levels of diabetes distress (reference = no diabetes distress) in 228 individuals with Type 1 diabetes and 2534 individuals with Type 2 diabetes interviewed in the National Health Interview Survey in 2021.

RESULTS

Among adults with Type 1 diabetes, 41.2% experienced moderate diabetes distress and 19.1% experienced high diabetes distress, and among adults with Type 2 diabetes, 40.8% experienced moderate diabetes distress and 10.0% experienced high diabetes distress. In adults with Type 1 diabetes, experiencing delayed medical care was associated with an adjusted odds ratio (aOR) of 4.31 (95% CI: 1.91-9.72) for moderate diabetes distress and 3.69 (95% CI: 1.20-11.30) for high diabetes distress. In adults with Type 2 diabetes, experiencing delayed medical care was associated with an aOR of 1.61 (95% CI: 1.25-2.07) for moderate diabetes distress and 2.27 (95% CI: 1.48-3.49) for high diabetes distress. Similar associations were observed between not receiving medical care due to the pandemic and diabetes distress.

CONCLUSION

Among people with diabetes, experiencing delayed medical care and not receiving care due to the pandemic were associated with higher reports of diabetes distress.

Prevalence and the association between clinical factors and Diabetes-Related Distress (DRD) with poor glycemic control in patients with type 2 diabetes: A Northern Thai cross-sectional study

BACKGROUND

Glycemic control is important to prevent diabetic complications. However, evidence linking factors such as diabetes-related distress (DRD) to poor glycemic outcomes is lacking in Thailand. Therefore, this study aimed to investigate the prevalence and associated factors of poor glycemic control type 2 diabetes.

METHODS

A cross-sectional study was conducted on 127 type 2 diabetic patients between December 2021 and March 2022 at Maharaj Nakorn Chiang Mai Hospital, Thailand. Data collection included demographic data, clinical data (duration of being type 2 diabetes, diabetic treatment modalities, weight, height, blood pressure, FBS, and HbA1c), behavioral data (self-care behavior, physical activity, dietary assessment, smoking, alcohol consumption, and sleep quality), and psycho-social data (depression and DRD). Poor glycemic control was defined as not achieving the target HbA1c based on the 2021 American Diabetes Association (ADA) Guideline. Multivariable logistic regression was used to explore the associations between potential factors including DRD, and poor glycemic control.

RESULTS

The prevalence of poor glycemic control in patients with type 2 diabetes was 29.1%. Our analysis revealed that age under 65 years old (OR 6.40, 95% CI 2.07-19.77, p = 0.001), obesity (BMI ≥ 25 kg/m2) (OR 2.96, 95% CI 1.05-8.39, p = 0.041), and DRD (OR 14.20, 95% CI 3.76-53.64, p<0.001) were significantly associated with poor glycemic control. Three dimensions of DRD were associated with poor glycemic control, including emotional distress (OR 4.23, 95% CI 1.51-11.85, p = 0.006), regimen-related distress (OR 6.00, 95% CI 1.88-19.18, p = 0.003), and interpersonal distress (OR 5.25, 95% CI 1.39-20.02, p = 0.015).

CONCLUSION AND RECOMMENDATION

Age, obesity, and DRD are associated with poor glycemic control. A holistic approach that includes addressing DRD is crucial for improving glycemic outcomes in patients with type 2 diabetes. Further studies in broader populations using a cohort design are recommended.

The association between early maladaptive schemas and glycaemic control in patients with type 2 diabetes mellitus: A cross-sectional study

INTRODUCTION

Diabetes is a disease with high prevalence and causes heavy economic burden. Mental and physical health are tied together and their interaction determines one's health or sickness. Early maladaptive schemas (EMSs) are suitable indicators of mental health. We investigated the association between EMSs and glycaemic control in type 2 diabetes mellitus (T2DM) patients.

METHODS

We conducted a cross-sectional study in 2021 on 150 patients with T2DM. We used two questionnaires a demographic data questionnaire, and a Young Schema Questionnaire 2 - Short Form for gathering the data. We also performed laboratory tests on our participants and used the results of fasting blood sugar and haemoglobin A1 c to evaluate glycaemic control.

RESULTS

Most of our participants were females (66%). Most of our patients were 41-60 years old (54%). There were only three single participants, and 86.6% of our individuals did not have a university degree. Total mean ± SD for EMSs score was 192.45 ± 55.66; self-sacrifice (19.09 ± 4.64) and defectiveness/shame (8.72 ± 4.45) had the highest and lowest EMSs scores, respectively. None of the demographic data had any significant impact on EMSs scores or glycaemic control, but generally, younger patients with higher levels of education had better glycaemic control. Participants with higher scores for defectiveness/shame and insufficient self-control had significantly worse glycaemic control.

CONCLUSION

Mental and physical health are tied together, and paying attention to psychological aspects in prevention and management of physical disorders is crucial. EMSs, especially defectiveness/shame and insufficient self-control are associated with glycaemic control of T2DM patients.

Resilience, self-efficacy and diabetes distress on self-management behaviours in patients newly diagnosed with type 2 diabetes: A moderated mediation analysis

AIM

To examine (1) the mediating role of self-efficacy between resilience and self-management behaviours and (2) the moderating role of diabetes distress on the relationship between self-efficacy and self-management behaviours in patients newly diagnosed with type 2 diabetes.

DESIGN

Cross-sectional design.

METHODS

Totally, 195 patients newly diagnosed with type 2 diabetes for more than 5 months but less than 18 months were recruited from three endocrine clinics in Taiwan through convenience sampling. Self-reported questionnaires including demographic and disease characteristics, resilience, self-efficacy and self-management behaviours were used to collect data from October 2020 to May 2021. Moderated mediation analysis was performed by Hayes's PROCESS macro.

RESULT

According to bootstrapping results, the indirect effect of resilience on self-management was significant, although the direct effect of resilience on self-management was not. Participants were categorized into with and without diabetes distress groups. The results of moderated mediation analysis indicated self-efficacy significantly correlated with self-management behaviours in participants without diabetes distress, although self-efficacy did not significantly correlate with self-management in participants with diabetes distress.

CONCLUSION

The association of resilience with self-management behaviours was fully mediated through self-efficacy with diabetes distress moderating the relationship between self-efficacy and self-management behaviours in patients newly diagnosed with type 2 diabetes.

IMPACT

Improving resilience could enhance self-efficacy leading to possible improvement in self-management behaviour, although improving self-efficacy might not benefit self-management behaviours for those with high levels of diabetes distress. Healthcare providers need to first assess and address the diabetes distress before intervening to improve self-efficacy to enhance self-management behaviours in patients newly diagnosed with type 2 diabetes.

PATIENT OR PUBLIC CONTRIBUTION

When designing this study, two patients newly diagnosed with diabetes were consulted about the importance of self-management behaviours for them personally.

The relationship between psychosocial factors, self-care, and blood sugar in an Appalachian population

Introduction

Appalachian residents are more likely than other populations to have Type 2 Diabetes Mellitus (T2DM) and to experience more severe complications from the disease, including excess and premature mortality.

Methods

This study examines health alongside sociodemographic factors, psychosocial factors (including knowledge, empowerment, social support/function, religiosity, distress), and perceived problems in diabetes management that may influence self-care and HbA1c among vulnerable rural residents. A survey of a community-based sample of 356 adults with diagnosed diabetes or HbA1c > 6.5 was conducted in six counties in Appalachian Kentucky.

Results

Findings suggest that neither religiosity nor social support/function mediate/moderate the relationship between psychosocial factors and dependent variables (problem areas in diabetes, T2DM self-care or HbA1c). Results also suggest that distress is a predictor of problem areas in diabetes, and both distress and empowerment are predictors of T2DM self-care.

Implications

This study addresses the gap in the literature concerning the influence of psychosocial factors on problem areas in diabetes, T2DM self-care and HbA1c among vulnerable rural residents, as well as the potential mediating/modifying effects of religiosity and social function/support. Future research is needed to inform strategies for identifying and addressing distress among vulnerable populations burdened by T2DM, including Appalachian adults.

Psychological Predictors of Adherence to Self-Care Behaviour amongst Patients with Type 2 Diabetes Mellitus (T2DM) Visiting Public Hospital, North India

Background and Aims

Patients with type 2 diabetes mellitus (T2DM) need a high degree of self-care behavior, treatment adherence, and good psychological health. Psychological health play a vital role in adherence to treatment regimen and self-management of diabetes. This study aims to identify the psychological predictors of self-care behaviors among patients with T2DM.

Methods

A descriptive cross-sectional survey was conducted at a diabetic clinic at a tertiary care hospital in North India. Structured pre-tested personal and clinical profile and self-efficacy, diabetes distress, depression and anxiety, and complications and fear of developing hypoglycaemia due to diabetes mellitus in the future are measured through standardized questionnaires.

Results

The mean age of the participants was 53.5 (±3.68) years, and 41.4% were in the overweight (BMI: 25.0-29.9) and obese (16.7%, BMI > 30) category. Self-care behaviours found significant association with self-efficacy (r = 0.34, P < 0.001), anxiety (r = -0.28, P < 0.001), depression (r = -0.28, P < 0.001) and diabetes-related distress (r = -0.30, P < 0.001). Further, self-efficacy (P = 0.001), diabetes distress (P < 0.001) and fear of developing hypoglycaemia (P < 0.001) were reported independent predictors of self-care behaviour in patients with T2DM.

Conclusions

The current study suggests that self-efficacy, fear of hypoglycaemia and emotional state played an important role in adherence to self-care behaviour in T2DM management. Patients with diabetes mellitus should be routinely screened for psychological factors at diabetes clinics. Thus, developing tailored interventions to raise belief and self-efficacy might be a useful way to increase the involvement of patients in treatment.

The benefits and challenges of established peer support programmes for patients, informal caregivers, and healthcare providers

PURPOSE

Peer support programmes that provide services for various health conditions have been in existence for many years; however, there is little study of their benefits and challenges. Our goal was to explore how existing peer support programmes help patients with a variety of health conditions, the challenges that these programmes meet, and how they are addressed.

METHODS

We partnered with 7 peer support programmes operating in healthcare and community settings and conducted 43 semi-structured interviews with key informants. Audiorecordings were transcribed and qualitative analysis was conducted using grounded theory methods.

RESULTS

Peer support programmes offer informational and psychosocial support, reduce social isolation, and connect patients and caregivers to others with similar health issues. These programmes provide a supportive community of persons who have personal experience with the same health condition and who can provide practical information about self-care and guidance in navigating the health system. Peer support is viewed as different from and complementary to professional healthcare services. Existing programmes experience challenges such as matching of peer supporter and peer recipient and maintaining relationship boundaries. They have gained experience in addressing some of these challenges.

CONCLUSIONS

Peer support programmes can help persons and caregivers manage health conditions but also face challenges that need to be addressed through organizational processes. Peer support programmes have relevance for improving healthcare systems, especially given the increased focus on becoming more patient-centred. Further study of peer programmes and their relevance to improving individuals' well-being is warranted.

Equity in Psychosocial Outcomes and Care for Racial and Ethnic Minorities and Socioeconomically Disadvantaged People With Diabetes

The role of social determinants of health (SDOH) in promoting equity in diabetes prevalence, incidence, and outcomes continues to be documented in the literature. Less attention has focused on disparities in psychosocial aspects of living with diabetes and the role of SDOH in promoting equity in psychosocial outcomes and care. In this review, the authors describe racial/ethnic and socioeconomic disparities in psychosocial aspects of living with diabetes, discuss promising approaches to promote equity in psychosocial care, and provide future research directions.

Effects of the Norfolk diabetes prevention lifestyle intervention (NDPS) on glycaemic control in screen-detected type 2 diabetes: a randomised controlled trial

BACKGROUND

The purpose of this trial was to test if the Norfolk Diabetes Prevention Study (NDPS) lifestyle intervention, recently shown to reduce the incidence of type 2 diabetes in high-risk groups, also improved glycaemic control in people with newly diagnosed screen-detected type 2 diabetes.

METHODS

We screened 12,778 participants at high risk of type 2 diabetes using a fasting plasma glucose and glycosylated haemoglobin (HbA1c). People with screen-detected type 2 diabetes were randomised in a parallel, three-arm, controlled trial with up to 46 months of follow-up, with a control arm (CON), a group-based lifestyle intervention of 6 core and up to 15 maintenance sessions (INT), or the same intervention with additional support from volunteers with type 2 diabetes trained to co-deliver the lifestyle intervention (INT-DPM). The pre-specified primary end point was mean HbA1c compared between groups at 12 months.

RESULTS

We randomised 432 participants (CON 149; INT 142; INT-DPM 141) with a mean (SD) age of 63.5 (10.0) years, body mass index (BMI) of 32.4 (6.4) kg/m2, and HbA1c of 52.5 (10.2) mmol/mol. The primary outcome of mean HbA1c at 12 months (CON 48.5 (9.1) mmol/mol, INT 46.5 (8.1) mmol/mol, and INT-DPM 45.6 (6.0) mmol/mol) was significantly lower in the INT-DPM arm compared to CON (adjusted difference -2.57 mmol/mol; 95% CI -4.5, -0.6; p = 0.007) but not significantly different between the INT-DPM and INT arms (-0.55 mmol/mol; 95% CI -2.46, 1.35; p = 0.57), or INT vs CON arms (-2.14 mmol/mol; 95% CI -4.33, 0.05; p = 0.07). Subgroup analyses showed the intervention had greater effect in participants < 65 years old (difference in mean HbA1c compared to CON -4.76 mmol/mol; 95% CI -7.75, -1.78 mmol/mol) than in older participants (-0.46 mmol/mol; 95% CI -2.67, 1.75; interaction p = 0.02). This effect was most significant in the INT-DPM arm (-6.01 mmol/mol; 95% CI -9.56, -2.46 age < 65 years old and -0.22 mmol/mol; 95% CI -2.7, 2.25; aged > 65 years old; p = 0.007). The use of oral hypoglycaemic medication was associated with a significantly lower mean HbA1c but only within the INT-DPM arm compared to CON (-7.0 mmol/mol; 95% CI -11.5, -2.5; p = 0.003).

CONCLUSION

The NDPS lifestyle intervention significantly improved glycaemic control after 12 months in people with screen-detected type 2 diabetes when supported by trained peer mentors with type 2 diabetes, particularly those receiving oral hypoglycaemics and those under 65 years old. The effect size was modest, however, and not sustained at 24 months.

TRIAL REGISTRATION

ISRCTN34805606 . Retrospectively registered 14.4.16.