Skip to main content
SpringerLink
Log in

The relationship between diabetes distress, medication taking, glycaemic control and self-management

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background Diabetes distress (DD) has broad-ranging effects on type 2 diabetes (T2DM) management and outcomes. DD research is scarce among ethnic minority groups, particularly Arabic-speaking immigrant communities. To improve outcomes for these vulnerable groups, healthcare providers, including pharmacists, need to understand modifiable predictors of DD. Aim To assess and compare DD and its association with medication-taking behaviours, glycaemic control, self-management, and psychosocial factors among first-generation Arabic-speaking immigrants and English-speaking patients of Anglo-Celtic background with diabetes, and determine DD predictors. Setting Various healthcare settings in Australia. Method A multicentre cross-sectional study was conducted. Adults with T2DM completed a survey comprised of validated tools. Glycated haemoglobin, blood pressure, and lipid profile were gathered from medical records. Multiple linear regression models were computed to assess the DD predictors. Main outcome measure Diabetes distress level. Results Data was analysed for 696 participants: 56.3% Arabic-speaking immigrants and 43.7% English-speaking patients. Compared with English-speaking patients, Arabic-speaking immigrants had higher DD, lower medication adherence, worse self-management and glycaemic control, and poorer health and clinical profile. The regression analysis demonstrated that higher DD in Arabic-speaking immigrants was associated with cost-related medication underuse and lower adherence to exercise, younger age, lower education level, unemployment, lower self-efficacy, and inadequate glycaemic control. Whereas among English-speaking patients, higher DD was associated with both cost- and non-cost-related underuse of medication and lower dietary adherence. Conclusion Results provided new insights to guide healthcare providers on reducing the apparent excess burden of DD among Arabic-speaking immigrants and potentially improve medication adherence, glycaemic control, and self-management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Data is available from the author by request.

References

  1. Ogurtsova K, da Rocha Fernandes JD, Huang Y, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017;128:40–50.

    CAS  PubMed  Google Scholar 

  2. Bommer C, Heesemann E, Sagalova V, et al. The global economic burden of diabetes in adults aged 20–79 years: a cost-of-illness study. Lancet Diabetes Endocrinol. 2017;5(6):423–30.

    PubMed  Google Scholar 

  3. Stark SC, Fradkin JE, Saydah SH, et al. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988–2010. Diabetes Care. 2013;36(8):2271–9.

    Google Scholar 

  4. Young-Hyman D, de Groot M, Hill-Briggs F, et al. Psychosocial care for people with diabetes: a position statement of the american diabetes association. Diabetes Care. 2016;39(12):2126–40.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Guo H, Wang X, Mao T, et al. How psychosocial outcomes impact on the self-reported health status in type 2 diabetes patients: findings from the diabetes attitudes, wishes and needs (DAWN) study in eastern China. PLoS One. 2018;13(1):e0190484.

    PubMed  PubMed Central  Google Scholar 

  6. Fisher L, Skaff MM, Mullan JT, et al. Clinical depression versus distress among patients with type 2 diabetes. Diabetes Care. 2007;30(3):542–8.

    PubMed  Google Scholar 

  7. Das-Munshi J, Stewart R, Ismail K, et al. Diabetes, common mental disorders, and disability: findings from the UK National Psychiatric Morbidity Survey. Psychosom Med. 2007;69(6):543–50.

    PubMed  Google Scholar 

  8. Fisher L, Hessler D, Glasgow RE, et al. REDEEM: a pragmatic trial to reduce diabetes distress. Diabetes Care. 2013;36(9):2551–8.

    PubMed  PubMed Central  Google Scholar 

  9. Fisher L, Hessler DM, Polonsky WH, et al. When is diabetes distress clinically meaningful?: establishing cut points for the diabetes distress scale. Diabetes Care. 2012;35(2):259–64.

    PubMed  PubMed Central  Google Scholar 

  10. Fisher L, Mullan JT, Arean P, et al. Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care. 2010;33(1):23–8.

    PubMed  Google Scholar 

  11. Chew B-H, Mohd-Sidik S, Shariff-Ghazali S. Negative effects of diabetes–related distress on health-related quality of life: an evaluation among the adult patients with type 2 diabetes mellitus in three primary healthcare clinics in Malaysia. Health Qual Life Outcomes. 2015;13:187.

    PubMed  PubMed Central  Google Scholar 

  12. van Dooren FEP, Nefs G, Schram MT, et al. Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis. Plos One. 2013;8(3):e57058.

    PubMed  PubMed Central  Google Scholar 

  13. Fisher L, Mullan JT, Skaff MM, et al. Predicting diabetes distress in patients with Type 2 diabetes: a longitudinal study. Diabet Med. 2009;26(6):622–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Polonsky WH, Anderson B, Lohrer P, et al. Assessment of diabetes-related distress. Diabetes Care. 1995;18(6):754–60.

    CAS  PubMed  Google Scholar 

  15. Jannoo Z, Wah YB, Lazim AM, et al. Examining diabetes distress, medication adherence, diabetes self-care activities, diabetes-specific quality of life and health-related quality of life among type 2 diabetes mellitus patients. J Cli Transl Endocrinol. 2017;9:48–54.

    Google Scholar 

  16. Maljanian R, Grey N, Staff I, et al. Improved diabetes control through a provider-based disease management program. Dis Manag Health Out. 2002;10:1–8.

    Google Scholar 

  17. Miller-Rosales C, Rodriguez HP. Interdisciplinary primary care team expertise and diabetes care management. J Am Board Fam Med. 2021;34(1):151–61.

    PubMed  Google Scholar 

  18. Campbell RK. Role of the pharmacist in diabetes management. Am J Health-system Pharmacy. 2002;59(Suppl 9):S18-21.

    Google Scholar 

  19. Rashid JR, Leath BA, Truman BI, et al. Translating comparative effectiveness research into practice: effects of interventions on lifestyle, medication adherence, and self-care for type 2 diabetes, hypertension, and obesity among black, hispanic, and asian residents of Chicago and Houston, 2010 to 2013. J Public Health Manag Pract. 2017;23(5):468–76.

    PubMed  Google Scholar 

  20. Dieter T, Lauerer J. Depression or diabetes distress? Perspect Psychiatr Care. 2018;54(1):84–7.

    PubMed  Google Scholar 

  21. Sturt J, Dennick K, Hessler D, et al. Effective interventions for reducing diabetes distress: systematic review and meta-analysis. Int Diabet Nurs. 2015;12:40–55.

    Google Scholar 

  22. Schmidt CB, Potter van Loon BJ, Torensma B, et al. Ethnic minorities with diabetes differ in depressive and anxiety symptoms and diabetes-distress. J Diabet Res. 2017;2017:1204237.

    Google Scholar 

  23. Attridge M, Creamer J, Ramsden M, et al. Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2014;(9):CD006424.

  24. Tenkorang EY. Early onset of type 2 diabetes among visible minority and immigrant populations in Canada. Ethn Health. 2017;22(3):266–84.

    PubMed  Google Scholar 

  25. Alzubaidi H, Mc Narmara K, Kilmartin G, et al. The relationships between illness and treatment perceptions with adherence to diabetes self-care: a comparison between Arabic-speaking migrants and Caucasian English-speaking patients. Diabet Res Clin Pract. 2015;110(2):208–17.

    Google Scholar 

  26. Alzubaidi H, Mc Namara K, Browning C, et al. Barriers and enablers to healthcare access and use among Arabic-speaking and Caucasian English-speaking patients with type 2 diabetes mellitus: a qualitative comparative study. BMJ Open. 2015;5(11):e008687.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Alzubaidi H, Mc Mamara K, Chapman C, et al. Medicine-taking experiences and associated factors: comparison between Arabic-speaking and Caucasian English-speaking patients with Type 2 diabetes. Diabet Med. 2015;32(12):1625–33.

    CAS  PubMed  Google Scholar 

  28. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.

    CAS  PubMed  Google Scholar 

  29. Aikens JE, Piette JD. Diabetic patients’ medication underuse, illness outcomes, and beliefs about antihyperglycemic and antihypertensive treatments. Diabetes Care. 2009;32(1):19–24.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Toobert D, Hampson S, Glasgow R. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23:943–50.

    CAS  PubMed  Google Scholar 

  31. Peterson PN, Shetterly SM, Clarke CL, et al. Health literacy and outcomes among patients with heart failure. JAMA. 2011;305(16):1695–701.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Chao J, Nau DP, Aikens JE, et al. The mediating role of health beliefs in the relationship between depressive symptoms and medication adherence in persons with diabetes. Res Social Adm Pharm. 2005;1(4):508–25.

    PubMed  Google Scholar 

  33. Cherrington A, Wallston K, Rothman R. Exploring the relationship between diabetes self-efficacy, depressive symptoms, and glycemic control among men and women with type 2 diabetes. J Behav Med. 2010;33(1):81–9.

    PubMed  PubMed Central  Google Scholar 

  34. Polonsky WH, Fisher L, Earles J, et al. Assessing psychosocial distress in diabetes. Diabet Care. 2005;28(3):626–31.

    Google Scholar 

  35. Özcan B, Rutters F, Snoek FJ, et al. High diabetes distress among ethnic minorities is not explained by metabolic, cardiovascular, or lifestyle factors: findings from the dutch diabetes pearl cohort. Diabetes Care. 2018;41(9):1854–61.

    PubMed  Google Scholar 

  36. Pousinho S, Morgado M, Falcão A, et al. Pharmacist interventions in the management of type 2 diabetes mellitus: a systematic review of randomized controlled trials. J Manag Care Spec Pharm. 2016;22(5):493–515.

    PubMed  Google Scholar 

  37. Armor BL, Britton ML, Dennis VC, et al. A review of pharmacist contributions to diabetes care in the United States. J Pharm Pract. 2010;23(3):250–64.

    PubMed  Google Scholar 

  38. Pousinho S, Morgado M, Plácido AI, et al. Clinical pharmacists´ interventions in the management of type 2 diabetes mellitus: a systematic review. Pharm Pract. 2020;18(3):2000.

    Google Scholar 

  39. Alsuwayni B, Alhossan A. Impact of clinical pharmacist-led diabetes management clinic on health outcomes at an academic hospital in Riyadh, Saudi Arabia: a prospective cohort study. Saudi Pharm J. 2020;28(12):1756–9.

    PubMed  PubMed Central  Google Scholar 

  40. Dennick K, Sturt J, Speight J. What is diabetes distress and how can we measure it? A narrative review and conceptual model. J Diabet Complicat. 2017;31(5):898–911.

    Google Scholar 

  41. Abuelezam NN, Abdulrahman ME-S, Galea S. The health of Arab Americans in the United States: an updated comprehensive literature review. Front Public Health. 2018;6:262.

    PubMed  PubMed Central  Google Scholar 

  42. Nguyen V, Tran T, Dang T, et al. Diabetes-related distress and its associated factors among patients with diabetes in Vietnam. Psychol Res Behav Manag. 2020;13:1181–9.

    PubMed  PubMed Central  Google Scholar 

  43. Helgeson VS, Van Vleet M, Zajdel M. Diabetes stress and health: is aging a strength or a vulnerability? J Behav Med. 2020;43:426–36.

    PubMed  Google Scholar 

  44. Dahlgren G, Whitehead M. Policies and Strategies to Promote Social Equity in Health. Sweden Institute for Futures Studies: Stockholm; 1991.

    Google Scholar 

  45. Mathiesen AS, Egerod I, Jensen T, et al. Psychosocial interventions for reducing diabetes distress in vulnerable people with type 2 diabetes mellitus: a systematic review and meta-analysis. Diabet Metab Syndr Obes. 2018;12:19–33.

    Google Scholar 

  46. Hoogendoorn CJ, Schechter CB, Llabre MM, et al. Distress and type 2 diabetes self-care: putting the pieces together. Ann Behav Med. 2020. https://doi.org/10.1093/abm/kaaa070.

    Article  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors sincerely thank study participants for sharing their real views and experiences, and staff who supported recruitment at the participating study sites. Special thanks to Mr. Ward Saidawi for his outstanding efforts in data management.

Funding

This research was supported by an operational Grant from the University of Sharjah and an internal grant from the Centre for Medicine Use and Safety, Monash University.

Author information

Authors and Affiliations

  1. Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates

    Hamzah Alzubaidi

  2. Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates

    Hamzah Alzubaidi & Catarina Samorinha

  3. Department of Mathematics and Statistics, American University of Sharjah, Sharjah, United Arab Emirates

    Hana Sulieman

  4. School of Medicine, Deakin University, Victoria, Australia

    Kevin Mc Namara

  5. Centre for Population Health Research, Deakin University, Burwood, VIC, Australia

    Kevin Mc Namara

  6. School of Nursing and Healthcare Professions, Federation University, Ballarat, VIC, Australia

    Colette Browning

  7. Australian National University, Australian Capital Territory, Canberra, Australia

    Colette Browning

Authors
  1. Hamzah Alzubaidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hana Sulieman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kevin Mc Namara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Catarina Samorinha
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Colette Browning
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hamzah Alzubaidi.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethics approval

Approval was obtained from the Monash University Human Research Ethics Committee (CF09/0956: 2009000462) and ethics committees at participating hospitals.

Consent to participate

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

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alzubaidi, H., Sulieman, H., Mc Namara, K. et al. The relationship between diabetes distress, medication taking, glycaemic control and self-management. Int J Clin Pharm 44, 127–137 (2022). https://doi.org/10.1007/s11096-021-01322-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-021-01322-2

Keywords

Search

Navigation