Quality of Life Research

, Volume 28, Issue 2, pp 491–501 | Cite as

Risk factors and quality of life of patients with high diabetes-related distress in primary care: a cross-sectional, multicenter study

  • Sze Mian Lim
  • Melanie Yee Lee Siaw
  • Keith Yu Kei Tsou
  • Kwee Keng Kng
  • Joyce Yu-Chia LeeEmail author



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.


Type 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.

Ethical approval

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.

Informed consent

Written informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Sze Mian Lim
    • 1
  • Melanie Yee Lee Siaw
    • 1
  • Keith Yu Kei Tsou
    • 2
  • Kwee Keng Kng
    • 3
  • Joyce Yu-Chia Lee
    • 1
    • 3
    Email author
  1. 1.Department of Pharmacy, Faculty of ScienceNational University of SingaporeSingaporeSingapore
  2. 2.Department of Family MedicineNational University PolyclinicsSingaporeSingapore
  3. 3.Department of PharmacyTan Tock Seng HospitalSingaporeSingapore

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