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

Medical alliances and diabetes-related distress in China: role of self-efficacy as a partial mediator

BACKGROUND

The prevalence of diabetes-related distress is high among diabetes mellitus patients, causing physical, psychological and economic burdens. China's general medical alliances and compact general alliances provide treatment for patients with type 2 diabetes mellitus (T2DM). This study aims to analyse the influence of medical alliances on diabetes-related distress and verified the mediating role of self-efficacy among T2DM patients.

METHODS

From one general and one compact medical alliance, data on 2156 T2DM adults >45 y of age were investigated through a questionnaire survey conducted in China. Diabetes-related distress, medical alliance data, self-efficacy information and control variables were collected. Hierarchical linear regression mediation analysis was used to analyse the influence of compact medical alliances and general medical alliances on diabetes-related distress and to verify self-efficacy as a mediator between medical alliances and diabetes-related distress.

RESULTS

Most patients (94.57%) with T2DM were suffering from diabetes-related distress, with an average score of diabetes-related distress (11.77±7.65). The respondents from compact medical alliances had lower diabetes-related distress (11.08±8.64) than from general medical alliances (12.38±6.61). Self-efficacy mediated the association between the type of medical alliance and diabetes-related distress (p<0.05). Higher income, lower health expenditure, lower education level, less sleep time, low physical exercise and low diabetes cognition were significant risk factors of diabetes-related distress (p<0.05).

CONCLUSIONS

Compact medical alliances reduced diabetic patients' diabetes-related distress significantly more than general medical alliances. Self-efficacy was a mediator between medical alliances and diabetes-related distress. Accelerating the transformation of the compact medical alliances can decrease diabetes-related distress and provide an integrated program of education, diabetes cognition and optimal sleep and exercise regimens to reduce diabetes-related distress.

The mediating role of expectations regarding aging between diabetes distress and self-management behaviors in older adults with type 2 diabetes mellitus

OBJECTIVES

To investigate the relationships among diabetes stress, expectations regarding aging, and self-management behaviors in older adults with type 2 diabetes mellitus.

METHODS

In this cross-sectional study, we surveyed 257 older patients aged ≥60 years with type 2 diabetes mellitus using the Diabetes Distress Scale, the 21-item Expectations Regarding Aging Scale, and the Diabetes Self-Care Behavior Scale. We conducted correlation and mediation analyses using SPSS 26.0 and PROCESS software.

RESULTS

Diabetes distress was negatively associated with diabetes self-management and expectations regarding aging. Expectations regarding aging were positively associated with diabetes self-management. Expectations regarding aging partially mediated the relationship between diabetes distress and self-management.

CONCLUSIONS

The self-management behavior of older patients with type 2 diabetes mellitus can be improved by reducing diabetes-related distress and increasing expectations regarding aging. Therefore, healthcare professionals should emphasize the mental health of older patients with type 2 diabetes mellitus and provide timely education on healthy aging.

Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations

People with diabetes often encounter stigma (ie, negative social judgments, stereotypes, prejudice), which can adversely affect emotional, mental, and physical health; self-care, access to optimal health care; and social and professional opportunities. To accelerate an end to diabetes stigma and discrimination, an international multidisciplinary expert panel (n=51 members, from 18 countries) conducted rapid reviews and participated in a three-round Delphi survey process. We achieved consensus on 25 statements of evidence and 24 statements of recommendations. The consensus is that diabetes stigma is driven primarily by blame, perceptions of burden or sickness, invisibility, and fear or disgust. On average, four in five adults with diabetes experience diabetes stigma and one in five experience discrimination (ie, unfair and prejudicial treatment) due to diabetes, such as in health care, education, and employment. Diabetes stigma and discrimination are harmful, unacceptable, unethical, and counterproductive. Collective leadership is needed to proactively challenge, and bring an end to, diabetes stigma and discrimination. Consequently, we achieved unanimous consensus on a pledge to end diabetes stigma and discrimination.