Identifying the burden and predictors of diabetes distress among adult Type 2 diabetes mellitus patients

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.

Prevalence of diabetes distress among type 2 diabetes mellitus patients in India: a systematic review and meta-analysis

Introduction

The burden of type 2 diabetes mellitus (T2DM) in India is on the rise, with projections indicating a staggering 134 million cases by 2045. Managing T2DM demands strict adherence, often resulting in mental strain and burnout. Diabetes distress (DD), a unique psychological burden, significantly affects motivation and self-care, contributing to increased morbidity and mortality.

Material and Methods

This study was conducted by doing a comprehensive literature search using PubMed (MEDLINE) and EMBASE databases for studies published from their inception to 14th August 2023 by using relevant keywords. The protocol is registered in PROSPERO and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Selected articles were meticulously screened based on predetermined inclusion and exclusion criteria. Joanna Briggs Institute (JBI) Critical Appraisal scale for cross-sectional study was used for assessing the study quality. Data analysis was done by using Jamovi 2.3.24 software.

Results

Following the systematic search and screening process, 10 cross-sectional studies were identified, comprising a total of 2,107 Type 2 Diabetes Mellitus patients. All studies employed the Diabetes Distress Scale-17 (DDS-17) for measurement. The prevalence of DD varied, ranging from 8.45% to 61.48%. The pooled prevalence of DD in T2DM patients in India was estimated at 33% (95% CI: 21%-45%) with substantial heterogeneity observed (I2 = 97.33%, P < 0.001). While an asymmetric funnel plot suggested potential publication bias, sensitivity analysis reinforced the robustness of our findings.

Conclusion

Policymakers, clinicians, and researchers can leverage these insights to prioritize the psychological well-being of T2DM patients, ultimately improving their overall health outcomes. This study aligns with the Sustainable Development Goals (SDGs) and India's national health policy, emphasizing the urgency of screening and treating diabetes-related distress by 2025.

Burden and predictors of distress among persons with type 2 diabetes mellitus: Excerpts of an observational study from Eastern India

Context

Diabetes distress (DD) is a common psychological condition distinct from depression. This is a unique, hidden emotional burden and worry that the patient experiences under ongoing treatment.

Aim

To assess the prevalence and predictors of DD among adult diabetics attending a tertiary healthcare facility.

Settings and Design

This hospital-based observational, analytical, cross-sectional study recruited 152 adult patients with type 2 diabetes.

Materials and Methods

The sociodemographic and diabetes-related information was collected with the help of a predesigned, structured proforma. Clinical and anthropometric examinations were conducted. Distress was determined by the standardized Diabetic Distress Scale (DDS). Statistical Analysis Used: The mean (SE) value was calculated for quantitative variables. The mean item score in DDS of ≥2 is taken as the presence of distress. Fisher's exact Chi-square test was done to check for association. Two-tailed significance test with a P value of < 0.05 was considered statistically significant.

Results

Majority of study participants were literate, married, and from the lower middle socioeconomic class. High blood pressure was the most common co-morbidity and tobacco use was the most prevalent addiction. The prevalence of diabetes distress was 77.0%. Emotional DD was found to be more common than regimen, interpersonal, and physician-related DD. The major determinants that emerged were young age, low socioeconomic class, physical inactivity, longer time duration to reach the hospital, associated known co-morbidities, and poor glycaemic control.

Conclusion

A target-specific and routine counseling sessions merged with pronged strategic services are essential to improve the mental health of respondents.

Diabetes-related distress and its associated factors among people with type 2 diabetes in Southeast Ethiopia: a cross-sectional study

BACKGROUND

Diabetes-related distress lowers the motivation for self-care, often leading to lowered physical and emotional well-being, poor diabetes control, poor medication adherence and increased mortality among individuals with diabetes.

OBJECTIVE

To assess factors associated with diabetes-related distress among people living with type 2 diabetes in Southeast Ethiopia.

DESIGN

Institution-based cross-sectional study was conducted.

SETTING

Six diabetic follow-up care units at public hospitals in Southeast Ethiopia.

PARTICIPANTS

All adult people living with type 2 diabetes from the diabetic follow-up clinic.

THE MAIN OUTCOME MEASURES

Diabetes Distress Scale-17 questionnaire was used to assess diabetes-related distress.

RESULTS

Out of the total 871 study participants intended, 856 participated in the study with a response rate of 98.3%. The findings showed that about 53.9% (95% CI 50.4% to 57.2%) of the patients have diabetes-related distress. Physical activity (adjusted OR, AOR 2.22; 95% CI 1.36 to 3.63), social support (AOR 4.41; 95% CI 1.62 to 12.03), glycaemic control (AOR 2.36; 95% CI 1.35 to 4.12) and other comorbidities (AOR 3.94; 95% CI 2.01 to 7.73) were factors that significantly associated with diabetes-related distress at p<0.05.

CONCLUSION

This study demonstrated that more than half of the participants had diabetes-related distress. Therefore, the identified factors of diabetes-related distress need to be a concern for health institutions and clinicians in the management of people living with type 2 diabetes.

Prevalence of diabetes distress and cross-cultural reliability of DDS-17 scale in rural Haryana

Background

Diabetes distress associated with diabetes is an important under-appreciated domain of diabetes management. The aim of the study is to assess the prevalence of diabetes distress among T2DM patients in Jhajjar district of Haryana, using widely accepted DDS-17 scale along with testing the scale's reliability through Cronbach's α.

Material and Methods

This observational study with cross-sectional design was carried out among 503 T2DM patients in district, Jhajjar, Haryana. DDS-17 scale was used for diabetes distress assessment. Data entry and analysis were performed using appropriate software.

Results

37.97% subjects had diabetes distress either in moderate (DDS-17 Score ≥2) or severe (DDS-17 Score ≥3) form. English version of DDS-17 scale showed good internal consistency reliability (α = 0.79).

Conclusions

This study conclusively showed that diabetes distress is very common among T2DM patients as more than one third of the T2DM patients had diabetes distress and diabetes distress scale (DDS-17) is an easy, well-accepted questionnaire with good reliability.

Factors Associated With Diabetes Distress Among Patients With Poorly Controlled Type 2 Diabetes

Objective

Examine factors associated with increased diabetes distress (DD) among patients with type 2 diabetes with DD assessed by Diabetes Distress Scale (DDS) total and subscale scores (emotional burden, physician-related distress, regimen-related distress, and interpersonal distress).

Methods

Cross-sectional analysis of data from veterans with persistently poorly controlled diabetes mellitus. Multivariable linear regression models included baseline patient characteristics (independent variables) and DDS total and subscale scores (dependent variable).

Results

The cohort's (N = 248) mean age was 58 years (SD 8.3); 21% were female, 79% were non-White, and 5% were Hispanic/Latinx. Mean hemoglobin A1c (HbA1c) was 9.8%, and 37.5% had moderate to high DD. Hispanic/Latinx ethnicity (β=0.41; 95% CI 0.01, 0.80), baseline HbA1c (0.07; 95% CI 0.01,0.13), and higher Personal Health Questionnaire-8 (PHQ-8) scores (0.07; 95% CI 0.05, 0.09) were associated with higher total DD. Hispanic/Latinx ethnicity (0.79; 95% CI 0.25, 1.34) and higher PHQ-8 (0.05; 95% CI 0.03, 0.08) were associated with higher interpersonal-related distress. Higher HbA1c (0.15; 95% CI 0.06, 0.23) and higher PHQ-8 scores (0.10; 95% CI 0.07, 0.13) were associated with higher regimen-related distress. The use of basal insulin (0.28; 95% CI 0.001, 0.56) and higher PHQ-8 (0.02; 95% CI 0.001, 0.05) were associated with higher physician-related distress. Higher PHQ-8 (0.10; 95% CI 0.07, 0.12) was associated with higher emotional burden.

Conclusion

Hispanic/Latinx ethnicity, depressive symptoms, uncontrolled hyperglycemia, and insulin use were associated with higher risk for DD. Future research should explore these relationships, and interventions designed to reduce diabetes distress should consider accounting for these factors.