Risk factors and quality of life of patients with high diabetes-related distress in primary care: a cross-sectional, multicenter study
This study aimed to examine risk factors and quality of life of patients with high diabetes-related distress (DRD) in primary care.
A cross-sectional, multicenter study was conducted in four primary healthcare institutions. Patients aged ≥ 21 years with T2DM were included; patients who were pregnant or unable to communicate independently were excluded from this study. The problem area in diabetes (PAID) measuring DRD, European quality of life-5 dimensions (EQ-5D), and audit of diabetes-dependent quality of life (ADDQoL) measuring quality of life were administered by trained research assistants.
A total of 525 patients were eligible for this study. The mean PAID score was 26.90 ± 20.23, with 27.8% of patients reporting having high DRD (PAID score ≥ 40). Patients who were younger than 50 years (OR 4.577, 95% CI 1.977–10.600) and patients with HbA1c greater than 9% (OR 1.720, 95% CI 1.064–2.779) were at higher risk of having high DRD (p < 0.05). Patients with high DRD have a lower EQ-5D index value (B = − 0.141) and ADDQoL AWI (B = − 1.276) than patients with little/no DRD (p < 0.001).
High DRD was more common among younger patients and patients with poorer glycemic control. High DRD was associated with poorer quality of life and early screening and management of DRD is recommended.
KeywordsType 2 diabetes mellitus Psychological distress Risk factors Quality of life Primary healthcare
The authors would like to thank Joslin Diabetes Center, Health Psychology Research Ltd, and EuroQol Research Foundation for granting us the permission to use the questionnaires in our study. In addition, we would also like to thank all the doctors, nurses, and staff for supporting this study.
This study was supported by a Health Services Research Competitive Research Grant (HSR CRG) from the Ministry of Health, Singapore (HSRG/11MAY/016).
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest in this study.
All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Written informed consent was obtained from all individual participants included in the study.
- 3.Peyrot, M., Tarkun, I., Ishii, H., Vallis, M., Wens, J., Holt, R. I. G., et al. (2013). Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabetic Medicine, 30(7), 767–777. https://doi.org/10.1111/dme.12245.Google Scholar
- 4.Lustman, P. J., & Harper, G. W. (1987). Nonpsychiatric physicians’ identification and treatment of depression in patients with diabetes. Comprehensive Psychiatry, 28(1), 22–27.Google Scholar
- 5.Rubin, R. R., Ciechanowski, P., Egede, L. E., Lin, E. H., & Lustman, P. J. (2004). Recognizing and treating depression in patients with diabetes. Current Diabetes Reports, 4(2), 119–125.Google Scholar
- 6.Pouwer, F., Beekman, A. T. F., Lubach, C., & Snoek, F. J. (2006). Nurses’ recognition and registration of depression, anxiety and diabetes-specific emotional problems in outpatients with diabetes mellitus. Patient Education and Counseling, 60(2), 235–240. https://doi.org/10.1016/j.pec.2005.01.009.Google Scholar
- 8.Unger, J. (2007). Diabetes management in primary care (Vol. Book, Whole). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.Google Scholar
- 10.Co, M. A., Tan, L. S. M., Tai, E. S., Griva, K., Amir, M., Chong, K. J., et al. (2015). Factors associated with psychological distress, behavioral impact and health-related quality of life among patients with type 2 diabetes mellitus. Journal of Diabetes and Its Complications, 29(3), 378–383. https://doi.org/10.1016/j.jdiacomp.2015.01.009.Google Scholar
- 11.Fisher, L., Mullan, J. T., Arean, P., Glasgow, R. E., Hessler, D., & Masharani, U. (2010). Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care, 33(1), 23–28. https://doi.org/10.2337/dc09-1238.Google Scholar
- 12.Pouwer, F., Skinner, T. C., Pibernik-Okanovic, M., Beekman, A. T. F., Cradock, S., Szabo, S., et al. (2005). Serious diabetes-specific emotional problems and depression in a Croatian–Dutch–English Survey from the European Depression in Diabetes [EDID] Research Consortium. Diabetes Research and Clinical Practice, 70(2), 166–173. https://doi.org/10.1016/j.diabres.2005.03.031.Google Scholar
- 14.van Dooren, F. E., Nefs, G. M., Schram, M. T., Verhey, F. R. J., Denollet, J., & Pouwer, F. (2013). Depression and risk of mortality in people with diabetes mellitus: A systematic review and meta-analysis. PLoS ONE, 8(3), e57058.Google Scholar
- 18.Delahanty, L. M., Grant, R. W., Wittenberg, E., Bosch, J. L., Wexler, D. J., Cagliero, E., et al. (2007). Association of diabetes-related emotional distress with diabetes treatment in primary care patients with Type 2 diabetes. Diabetic Medicine, 24(1), 48–54. https://doi.org/10.1111/j.1464-5491.2007.02028.x.Google Scholar
- 21.Sprenkle, M. D., Niewoehner, D. E., Nelson, D. B., & Nichol, K. L. (2004). The veterans short form 36 questionnaire is predictive of mortality and health-care utilization in a population of veterans with a self-reported diagnosis of asthma or copd. Chest, 126(1), 81–89. https://doi.org/10.1378/chest.126.1.81.Google Scholar
- 22.Wild, D., Grove, A., Martin, M., Eremenco, S., McElroy, S., Verjee-Lorenz, A., et al. (2005). Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: Report of the ISPOR task force for translation and cultural adaptation. Value in Health, 8(2), 94–104. https://doi.org/10.1111/j.1524-4733.2005.04054.x.Google Scholar
- 23.Rajaram, R. (2012). PDB35 validation of the problem areas in diabetes questionnaire among patients with Type 2 diabetes mellitus in Singapore: A pilot study. Value in Health, 15(7), A665.Google Scholar
- 24.Siaw, M. Y. L., Tai, B.-W. B., & Lee, J. Y.-C. (2016). Psychometric properties of the chinese version of problem areas in diabetes scale (SG-PAID-C) among high-risk polypharmacy patients with uncontrolled Type 2 diabetes in Singapore. Journal of Diabetes Investigation. https://doi.org/10.1111/jdi.12556.Google Scholar
- 26.Bradley, C., Todd, C., Gorton, T., Symonds, E., Martin, A., & Plowright, R. (1999). The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life: The ADDQoL. Quality of Life Research, 8(1/2), 79–91. https://doi.org/10.1023/A:1026485130100.Google Scholar
- 27.Soon, S. S., Goh, S. Y., Bee, Y. M., Poon, J. L., Li, S. C., Thumboo, J., et al. (2010). Audit of Diabetes-Dependent Quality of Life (ADDQoL) [Chinese version for Singapore] questionnaire: Reliability and validity among Singaporeans with type 2 diabetes mellitus. Applied Health Economics and Health Policy, 8(4), 239–249. https://doi.org/10.2165/11313920-000000000-00000.Google Scholar
- 30.Brown, J. B. (2014). The relationships between mindfulness, diabetes-related distress, selected demographic variables, and self-management in adults with type 2 diabetes. ProQuest Dissertations Publishing.Google Scholar
- 32.Fisher, L., Skaff, M. M., Mullan, J. T., Arean, P., Glasgow, R., & Masharani, U. (2008). A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetes. Diabetic Medicine, 25(9), 1096–1101. https://doi.org/10.1111/j.1464-5491.2008.02533.x.Google Scholar
- 33.Islam, M., Karim, M., Habib, S., & Yesmin, K. (2013). Diabetes distress among type 2 diabetic patients. International Journal of Medicine and Biomedical Research, 2(2), 113–124.Google Scholar
- 35.Pintaudi, B., Lucisano, G., Gentile, S., Bulotta, A., Skovlund, S. E., Vespasiani, G., et al. (2015). Correlates of diabetes-related distress in type 2 diabetes: Findings from the benchmarking network for clinical and humanistic outcomes in diabetes (BENCH-D) study. Journal of Psychosomatic Research, 79(5), 348–354. https://doi.org/10.1016/j.jpsychores.2015.08.010.Google Scholar
- 36.Carper, M. M., Traeger, L., Gonzalez, J. S., Wexler, D. J., Psaros, C., & Safren, S. A. (2014). The differential associations of depression and diabetes distress with quality of life domains in type 2 diabetes. Journal of Behavioral Medicine, 37(3), 501–510. https://doi.org/10.1007/s10865-013-9505-x.Google Scholar
- 37.Liu, M.-Y., Tai, Y.-K., Hung, W.-W., Hsieh, M.-C., & Wang, R.-H. (2010). Relationships between emotional distress, empowerment perception and self-care behavior and quality of life in patients with type 2 diabetes. The Journal of Nursing, 57(2), 49.Google Scholar