Prevalence and factors associated with diabetes-related distress among patients with type 2 diabetes mellitus in a South Indian secondary care hospital

Navaneethakrishnan R.; Cijoy K. Kuriakose

doi:10.18203/2320-6012.ijrms20253167

Authors

Navaneethakrishnan R. Department of Medicine, Christian Fellowship Hospital Oddanchatram, Dindigul, Tamil Nadu, India
Cijoy K. Kuriakose Department of Medicine, Christian Fellowship Hospital Oddanchatram, Dindigul, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20253167

Keywords:

Diabetes-related distress, Type 2 diabetes mellitus, Emotional burden

Abstract

Background: Diabetes related distress (DRD), though well known, is under-recognized in the Indian subcontinent. Existing literature is mostly from tertiary or teaching hospitals located in urban areas. The prevalence and determinants of DRD among non-urban settings is not well known. This study aims to fill this knowledge gap by investigating the same among patients with type 2 diabetes mellitus (T2DM) in a South Indian secondary care hospital.

Methods: 227 consecutive patients with T2DM were administered pre-validated diabetes distress scale questionnaire and their responses documented. The prevalence of distress in each of the four domains and as a whole was measured and the association with various factors were identified using appropriate statistical methods.

Results: 165 (72.7%), 164 (72.2%), 176 (77.5%) and 155 (68.3%) of patients experienced emotional distress, physician-related distress, regimen-related distress and interpersonal distress respectively. Overall, 165 (72.7%) had clinically significant diabetes-related distress in the study. Occurrence of hypoglycemic episodes (p 0.02), having high body mass index (BMI) (p 0.03) and non-adherence to a diet plan (p 0.03) were associated with increased distress in various domains.

Conclusions: Three out of four (165/227; 72.7%) adult patients living with T2DM reported experiencing DRD, a significantly higher prevalence than shown in previous studies. This highlights the need to incorporate DRD screening and management as part of routine care of T2DM. Prevalence of DRD was higher among patients who experienced hypoglycemia episodes in the month prior to the assessment. Scrupulous avoidance of hypoglycemia may help to reduce DRD among patients living with T2DM.

Metrics

Metrics Loading ...

References

Gonzalez JS, Fisher L, Polonsky WH. Depression in diabetes: have we been missing something important? Diabetes Care. 2011;34:236-9. DOI: https://doi.org/10.2337/dc10-1970

Ranjan R, Rajput M, Sachdeva A, Saha A, Jyotsana, Yadav K. Prevalence of diabetes distress and cross-cultural reliability of DDS-17 scale in rural Haryana. J Fam Med Prim Care. 2023;12(9):2064-9. DOI: https://doi.org/10.4103/jfmpc.jfmpc_496_23

Sankar P, Sasikumar P, Medayil R, Jacob R, Sasidharan S. High prevalence of distress among patients with type 2 diabetes: a hospital-based, cross-sectional study from south India. Diabetes. 2018;67:798-818. DOI: https://doi.org/10.2337/db18-2376-PUB

Gahlan D, Rajput R, Gehlawat P, Gupta R. Prevalence and determinants of diabetes distress in patients of diabetes mellitus in a tertiary care centre. Diabetes Metab Syndr. 2018;12(3):333-6. DOI: https://doi.org/10.1016/j.dsx.2017.12.024

German J, Kobe EA, Lewinski AA, Jeffreys AS, Coffman C, Edelman D, et al. Factors associated with diabetes distress among patients with poorly controlled type 2 diabetes. J Endocr Soc. 2023;7(5):bvad031. DOI: https://doi.org/10.1210/jendso/bvad031

Gonzalez JS, Kane NS, Binko DH, Shapira A, Hoogendoorn CJ. Tangled up in blue: unravelling the links between emotional distress and treatment adherence in type 2 diabetes. Diabetes Care. 2016;39(12):2182-9. DOI: https://doi.org/10.2337/dc16-1657

Adugnew M, Fetene D, Assefa T, Kedir S, Asmamaw K, Feleke Z, et al. Diabetes-related distress and its associated factors among people with type 2 diabetes in Southeast Ethiopia: a cross-sectional study. BMJ Open. 2024;14:e077693. DOI: https://doi.org/10.1136/bmjopen-2023-077693

Fisher L, Hessler DM, Polonsky WH, Mullan J. When is diabetes distress clinically meaningful? Establishing cut points for the diabetes distress scale. Diabetes Care. 2012;35(2):259-64. DOI: https://doi.org/10.2337/dc11-1572

Polonsky WH, Fisher L, Earles J, Dudl RJ, Lees J, Mullan J, et al. Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes Care. 2005;28(3):626-31. DOI: https://doi.org/10.2337/diacare.28.3.626

Chin YW, Lai PSM, Chia YC. The validity and reliability of the English version of the Diabetes Distress Scale for type 2 diabetes patients in Malaysia. BMC Fam Pract. 2017;18(1):25. DOI: https://doi.org/10.1186/s12875-017-0601-9

Banks J, Amspoker AB, Vaughan EM, Woodard L, Naik AD. Ascertainment of minimal clinically important differences in the diabetes distress scale-17: a secondary analysis of a randomized clinical trial. JAMA Netw Open. 2023;6(11):e2342950. DOI: https://doi.org/10.1001/jamanetworkopen.2023.42950

Sinha R, Priya A, Sinha A, Hifz Ur Rahman M. Prevalence of diabetes distress among type 2 diabetes mellitus patients in India: a systematic review and meta-analysis. Health Psychol Behav Med. 2024;12(1):2324091. DOI: https://doi.org/10.1080/21642850.2024.2324091

Shayeghian Z, Aguilar-Vafaie ME, Besharat MA, Amiri P, Parvin M, Gillani KR, et al. Self-care activities and glycated haemoglobin in Iranian patients with type 2 diabetes: can coping styles and social support have a buffering role? Psychol Health. 2015;30(2):153-64. DOI: https://doi.org/10.1080/08870446.2014.951651

Zhang Y, Zhang D, Long T, Wu Y, Huang J, Zhang Y, et al. Diabetes distress profiles and health outcomes of individuals with type 2 diabetes and overweight/obesity: a cluster analysis. Diabetes Res Clin Pract. 2024;217:111863. DOI: https://doi.org/10.1016/j.diabres.2024.111863

Amankwah-Poku M, Amoah AGB, Sefa-Dedeh A, Akpalu J. Psychosocial distress, clinical variables and self-management activities associated with type 2 diabetes: a study in Ghana. Clin Diabetes Endocrinol. 2020;6:14. DOI: https://doi.org/10.1186/s40842-020-00102-7

Fariba A, Amerzadeh M, Banazadeh M, Rashidi S, Myaneh ZT. Fear of hypoglycemia and illness perception in type II diabetes patients. BMC Endocr Disord. 2024;24(1):24. DOI: https://doi.org/10.1186/s12902-024-01548-x

Wu C, Wang W, Cheng S, Zhang H, Li L, Tian C, et al. The relationship between components of hypoglycemia worries and avoiding hypoglycemia behavior in type 2 diabetes mellitus with hypoglycemia: a network analysis. BMC Psychiatr. 2023;23(1):204. DOI: https://doi.org/10.1186/s12888-023-04698-9

Ali N, El Hamdaoui S, Nefs G, Walburgh Schmidt JWJ, Tack CJ, de Galan BE. High diabetes-specific distress among adults with type 1 diabetes and impaired awareness of hypoglycaemia despite widespread use of sensor technology. Diabet Med. 2023;40(9):e15167. DOI: https://doi.org/10.1111/dme.15167

Fagherazzi G. Technologies will not make diabetes disappear: how to integrate the concept of diabetes distress into care. Diabetes Epidemiol Manag. 2023;11. DOI: https://doi.org/10.1016/j.deman.2023.100140