IDF21-0009 Euthymia – An overlooked target in diabetes management

Abstract

Background: Euthymia can be described as a state of positive mental health, eustress, and psychological well-being. Diabetes distress (DD) is an emotional response characterised by extreme apprehension, discomfort or dejection, due to perceived inability in coping with the challenges and demands of living with diabetes. Differentiation of diabetes distress from clinical depression is crucial to implement appropriate treatment strategies. India harbours the world second largest population of diabetics but there is very less data on prevalence of DD. Aim: To assess the prevalence of Diabetes distress and its association with various parameters in subjects with T2DM in India. Method: Participants were 650 patients with T2DM attending OPD of an endocrine centre in north India. Detailed history, anthropometry and relevant investigations were carried out. DD was measured using a local language (Punjabi) version of Diabetes Distress Scale-17 (DDS-17). DDS is a validated 17- item self-report measure with each item scored on a Likert scale from 1 (no distress) to 6 (serious distress). It has sub-scales in 4 domains- Emotional burden (EB), Physician related, Regimen related and Interpersonal distress. Overall score < 2.0 indicates little or no distress, 2.0 - 2.9- moderate distress, and ≥ 3.0 - high distress. Data analysis used SPSS and p<0.005 was significant. Results: Mean age of participants was 48.6 ± 9.9 years. Prevalence of DD was 28.9%, with moderate distress in 20.4% and high distress in 8.5%. Mean total DD score was 2.27 ± 0.99. Mean score was higher in women (2.45 ± 1.17) than in men (1.95 ± 0.79) (p-0.02). Mean for EB, physician related, regimen related and interpersonal distress were (2.5 ± 0.91), (1.75 ± 0.69), (1.90 ± 0.94), (1.93 ± 0.78) respectively. Total DD had significant association with BMI, diabetes duration, Hba1c, neuropathy, nephropathy and insulin use. Discussion: Mental health dysfunction and hyperglycaemia have a bidirectional relationship, therefore in DM patients in addition to the evaluation of glycemic levels, measurement of distress is crucial for optimal outcomes. Our study using Punjabi version of DDS 17, identifies high prevalence of DD (28.9%) in Indian subjects with T2DM and the higher levels of distress in women. Our findings are similar to a meta-analysis by Perrin et al. which included 55 studies mainly from the western countries. As the burden of mental health dysfunction is high in DM patient, euthymia should be considered as an important target in diabetes care. Identification of cause of distress and optimisation of practical aspects of diabetes distress management, contributes for overall health and well-being of affected individual. Local language versions of DDS-17 can be conveniently used in clinical practice, for timely detection of DD and plan its appropriate management, which is purely based on patient–provider conversation and communication.