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

Author:

German Jashalynn1ORCID,Kobe Elizabeth A2ORCID,Lewinski Allison A34,Jeffreys Amy S3,Coffman Cynthia35,Edelman David3,Batch Bryan C1,Crowley Matthew J13

Affiliation:

1. Department of Medicine, Division of Endocrinology, Diabetes, & Metabolism, Duke University , Durham, NC 27710 , USA

2. Department of Medicine, Duke University Medical Center , Durham, NC 27710 , USA

3. Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System , Durham, NC 27705 , USA

4. Duke University School of Nursing , Durham, NC 27710 , USA

5. Department of Biostatistics and Bioinformatics, Duke University , Durham, NC 27710 , USA

Abstract

AbstractObjectiveExamine 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).MethodsCross-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).ResultsThe 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.ConclusionHispanic/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.

Funder

VA Health Services Research & Development

National Institutes of Health

Veterans Affairs Quality Enhancement Research Initiative

Veterans Affairs Office of Rural Health

National Institute on Minority Health and Health Disparities

Accelerate Discovery and Practice Transformation

Durham VA Health Care System

Publisher

The Endocrine Society

Subject

Endocrinology, Diabetes and Metabolism

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