Diabetes Distress Scale Scores Research Articles

Effect of Pharmacist-Led Interventions on Diabetes Distress Among People With Type 2 Diabetes.

The purpose of this study was to determine the effectiveness of pharmacist-led interventions on diabetes distress and glucose management among people with type 2 diabetes (T2DM) in a community care clinic. Adults with T2DM were recruited during routine visits at the pharmacist-run clinic. Participants completed a baseline A1C, demographic survey, Diabetes Distress Scale (DDS), and Patient Health Questionnaire-2 (PHQ-2). Depending on DDS subscale-specific responses, participants qualified for pharmacist-led educational interventions based on the ADCES7 Self-Care Behaviors™. After 6 months, participants completed another A1C, satisfaction survey, DDS, and PHQ-2. Data analysis included descriptive statistics and paired t tests. Among 53 participants at baseline, diabetes distress was present in 77.4%; emotional burden was most common in 64.2%, followed by regimen distress in 45.3%, interpersonal distress in 34.0%, and physician distress in 20.8%. After the intervention, significant reductions occurred in mean overall DDS score (2.0 to 1.7), emotional burden (2.4 to 1.8), regimen distress (2.3 to 1.7), A1C (7.0% to 6.5%; 53.0 to 47.5 mmol/mol), and PHQ-2 score (1.6 to 1.0). Participants were highly satisfied with the service, their knowledge, and self-management skills following completion of the study. Diabetes distress was present in most participants despite glucose management that was largely achieving treatment goals. Pharmacist-led educational interventions significantly reduced overall DDS score, emotional burden, regimen distress, A1C, and PHQ-2 score. The results of this study suggest that people with T2DM should receive routine screening for diabetes distress and that pharmacists can positively affect diabetes management and emotional well-being through tailored education.

Diabetes distress in a Barbadian population with type 2 diabetes: A pilot test.

To assess the psychometric properties of the Diabetes Distress Scale, in order to determine the feasibility, practicality, internal consistency and criterion validity of the instrument when used with Barbadians living with Type 2 Diabetes. Patients with type 2 diabetes, (n = 106. 60% females, 40% males; mean age = 65.2, 11.3 years) attending a private clinic in Barbados were assessed for diabetes distress, depression, glycated hemoglobin (HbA1C) and blood pressure (BP).A self-report questionnaire that included: clinical and demographic questions; the Diabetes Distress Scale (DDS); the Patient Health Questionnaire (PHQ-9); and the Problem Areas In Diabetes (PAID-5) scale. Glycated haemaglobin (HbA1C) and Blood pressure (BP) were also measured. Of the 110 persons who participated, 106 persons completed the questionnaire. The Cronbach alpha coefficient of the PAID was 0.92 and the DDS was 0.92. Concurrent validity was demonstrated in a strong consistent relationship between the scores on the DDS and PAID-5, with a strong positive correlation, r = 0.70, n = 86, p < 0.001. There was a significant difference in the DDS scores between males (M = 1.26, SD = 0.37) and females (M = 1.50, SD = 0.73), t(73.31) = -1.99, p = 0.05 two tailed. The DDS is shown to be a valid and reliable measure within this Caribbean context. Thus, researchers and clinicians desirous of a tool to assess Diabetes Distress may be assured of the strong psychometric properties demonstrated thus far.

691-P: Characteristics of People with Type 1 Diabetes Who Consider Fear of Hypoglycemia a Barrier to Their Diabetes Management

Hypoglycemia is a common side effect of insulin therapy, the constant threat of hypoglycemia symptoms and consequences may lead people with type 1 diabetes (T1D) to develop fear of hypoglycemia (FOH). This analysis aims to explore the characteristics of people who consider FOH as a barrier to managing diabetes. Methods: Self-reported data from an online T1D registry were analyzed to compare participants who consider FOH a barrier to those who do not (a registry-specific yes/no question) using χ2 test for categorical variables (gender, diabetes technology use, and hypoglycemia history) and the Mann-Whitney Test for age, T1D duration, Hypoglycemia Fear Survey (HFS-II), Hypoglycemia Confidence Survey (HCS), and Diabetes Distress Scale (DDS) scores. Results: Among 780 adults, 65% women, aged 44±15 years, had T1D for 25±15 years, 35% reported HbA1c≤ 7%, and 45% perceived FOH as a barrier. The prevalence of FOH as a barrier was higher in women, participants with history of symptomatic nocturnal or level 3 hypoglycemia, higher HbA1c, higher HFS and DDS scores, and lower HCS scores (Table 1). Conclusion: A significant proportion of adults, in particular women and those with a challenging T1D management (high HbA1c, history of hypoglycemia, diabetes distress, and low hypoglycemia confidence), consider FOH to be a barrier in T1D management, thus it needs to be considered as part of clinical follow-up. Disclosure M.K.Talbo: None. C.Leroux: None. L.Hill: None. A.Brazeau: Other Relationship; Dexcom, Inc., Diabète québec, Ordre des diététistes nutritionnistes du Québec, Research Support; Canadian Institutes of Health Research, Fonds de recherche du Québec en Santé.

Patient-reported outcomes for older adults on CamAPS FX closed loop system.

Use of the CamAPS FX hybrid closed loop (CL) system is associated with improved time in range and glycated haemoglobin A1c across the age span, but little is known about its effects on patient-reported outcomes (PROs). This open-label, randomized, multi-site study compared CamAPS FX to sensor-augmented pump (SAP) in a sample of older adults (≥60 years) with type 1 diabetes (T1D). Thirty-five older adults completed PROs surveys at the start of the study and after each period of 16 weeks using either CL or SAP. At the end of the study, 19 participated in interviews about their experiences with CL. Results examining the 16 weeks of CL use showed that the overall Diabetes Distress Scale score and two subscales (powerlessness and physician distress) improved significantly along with trust on the Glucose Monitoring Satisfaction Survey. User experience interview responses were consistent in noting benefits of 'improved glycaemic control' and 'worrying less about diabetes'. In this sample of older adults with T1D who have previously shown glycaemic benefit, there are indicators of improved PROs and subjective user experience benefits.

A scalable, virtual weight management program tailored for adults with type 2 diabetes: effects on glycemic control

BackgroundThe objective was to test the efficacy of a scalable, virtually delivered, diabetes-tailored weight management program on glycemic control in adults with type 2 diabetes (T2D).MethodsThis was a single arm, three-site clinical trial. Participants had baseline HbA1c between 7–11% and BMI between 27–50 kg/m2. Primary outcome was change in HbA1c at 24 weeks. Secondary outcomes were changes in body weight, waist circumference, the Diabetes Distress Scale (DDS), quality of life (IWQOL-L), and hunger (VAS). Generalized linear effects models were used for statistical analysis.ResultsParticipants (n = 136) were 56.8 ± 0.8 y (Mean ± SEM), 36.9 ± 0.5 kg/m2, 80.2% female, 62.2% non-Hispanic white. Baseline HbA1c, weight, and total DDS score were 8.0 ± 0.09%, 101.10 ± 1.47 kg, and 2.35 ± 0.08, respectively. At week 24, HbA1c, body weight, and total DDS decreased by 0.75 ± 0.11%, 5.74 ± 0.50%, 0.33 ± 0.10 units, respectively (all p < 0.001). Also, at week 24, quality of life increased by 9.0 ± 1.2 units and hunger decreased by 14.3 ± 2.4 units, (both p < 0.0001).ConclusionsThe scalable, virtually delivered T2D-tailored weight management program had favorable and clinically meaningful effects on glycemic control, body weight, and psychosocial outcomes.

Social Determinants of Health and Diabetes-Related Distress in Patients With Insulin-Dependent Type 2 Diabetes: Cross-sectional, Mixed Methods Approach.

BackgroundSocial determinants of health (SDOH) refer to the social, economic, and psychosocial conditions that influence health. Lower levels of SDOH factors including income, education, and employment are associated with a higher prevalence of diabetes, poorer glycemic control, and increased diabetes-related mortality. Few studies have conducted a comprehensive evaluation of multiple SDOH factors in a population with type 2 diabetes mellitus (T2DM).ObjectiveThis study aimed to identify the range of SDOH challenges—including diabetes-related distress—that impact patients with insulin-dependent diabetes at an urban safety-net clinic using the 5-domain SDOH framework developed by the Healthy People 2020 initiative.MethodsThe pilot study used a cross-sectional, mixed methods approach. Participants were recruited from 3 programs within a general internal medicine clinic that provides ambulatory care for patients with uncontrolled T2DM. We administered an investigator-developed SDOH survey based on the Healthy People 2020 framework and the validated Diabetes Distress Scale (DDS), which assesses 4 domains of diabetes-related distress. One-on-one interviews were conducted to gain in-depth information about challenges.ResultsIn total, 57 participants had an average hemoglobin A1c level of 11.0% (SD 2.6%). Overall, 92% (52/57) of participants had a barrier in at least one SDOH domain. SDOH challenges were most commonly reported in the domain of Health and Health Care (84%, 48/57), followed by Economic Stability (54%, n=31), Neighborhood and Built Environment (53%, n=30), Education and Health Literacy (47%, n=27), and Social and Community context (37%, n=21). The mean overall DDS score was 2.09 (SD 0.84), where scores of ≥2 indicate distress. Further, 79% (45/57) of participants had at least moderate diabetes-related distress in one of the 4 DDS domains. General themes that emerged from participant interviews included job interference with healthy behaviors, concerns about burdening others, challenges communicating with providers, and difficulty getting appointments in a timely manner.ConclusionsWe found high levels of SDOH barriers across all 5 domains of the Center for Disease Control and Prevention’s Healthy People 2020 framework, including significant levels of diabetes-related distress. Future programs to address SDOH barriers in patients with uncontrolled insulin-dependent diabetes should consider screening for and focusing on a wide range of challenges.

567-P: A Weight Management Program Tailored for Adults with Type 2 Diabetes: Effects on Glycemic Control

Background: Clinical weight loss interventions improve glycemic control in adults with type 2 diabetes (T2D) , but are costly and have limited accessibility. The objective of this trial was to test the efficacy of a diabetes-tailored widely available weight management program (WW, formerly Weight Watchers) on glycemic control in adults with T2D. Methods: This was a prospective 24-week single arm, three-site clinical trial. Participants (n= 136) had T2D, a baseline HbA1c between 7-11%, and a BMI between 27-50 kg/m2. All participants received the 24-wk intervention, which consisted of the WW digital + workshop program tailored for people with T2D, and included weekly virtual workshops and use of the WW App. Assessments occurred at baseline, wk 12 (83.8% retention) , and wk 24 (83.1%) . Primary outcome was change in HbA1c at 24 weeks. Secondary endpoints were changes in body weight and the Diabetes Distress Scale (DDS) . Generalized linear effects models were used for statistical analysis (MAR) and used an intent-to-treat analysis. Results: Participants were 56.8 ± 0.8 y (Mean ± SEM) , 80.2% Female, 62.2% non-Hispanic white. Baseline BMI was 36.2±0.6 kg/m2. Baseline HbA1c, weight, and total DDS score were 7.9±0.1%, 104.3±1.8 kg, and 2.2±0.1, respectively. HbA1c decreased 0.6±0.1% at wk 12 and 0.8±0.1% at wk 24 (both p &amp;lt;.0001) . Body weight decreased 4.6±0.5% at wk 12 and 5.7±0.5% at wk 24 (both p &amp;lt;.0001) . Total DDS score decreased 0.2±0.1 at wk 12 and 0.3±0.1 at wk 24 (both p &amp;lt;.0001) . Conclusions: The widely available WW program, modified for those with T2D, had favorable and clinically meaningful effects on glycemic control, body weight, and diabetes distress at 12 and 24 weeks. Disclosure J.W.Apolzan: Research Support; Mizkan Holdings, LLC , WW International, Inc. T.Bullard: Employee; WW International, Inc. G.D.Foster: Employee; WW International, Inc. M.Cardel: Employee; WW International, Inc. J.G.Larose: Research Support; WW International, Inc. S.D.Anton: None. R.A.Beyl: None. F.L.Greenway: Advisory Panel; General Nutrition Corporation, Jenny Craig, NovMeta Pharma, Nutraceutical Corporation, Pfizer Inc., Plensat, UR Labs, Consultant; Basic Research, Dr. Reddy’s Laboratories Ltd., Energesis, Gedeon Richter, Jazz Pharmaceuticals, Rejuvenate Bio, Other Relationship; Academic Technology Ventures, Inc., Melior Discoveries, Stock/Shareholder; Energesis, Ketogenic Health Systems, NovMeta Pharma, Plensat, Rejuvenate Bio, Slim Health Nutrition, UR Labs. E.P.Wickham: Board Member; American Board on Obesity Medicine, Research Support; National Institutes of Health, WW International, Inc. A.Lanoye: Research Support; WW International, Inc. M.N.Harris: None. A.Kaufman: Employee; WW International. Funding WW International, Inc.

Comparison of Collaborative Goal Setting With Enhanced Education for Managing Diabetes-Associated Distress and Hemoglobin A1c Levels

Type 2 diabetes is a prevalent and morbid condition. Poor engagement with self-management can contribute to diabetes-associated distress and hinder diabetes control. To evaluate the implementation and effectiveness of Empowering Patients in Chronic Care (EPICC), an evidence-based intervention to improve diabetes-associated distress and hemoglobin A1c (HbA1c) levels after the intervention and after 6-month maintenance. This hybrid (implementation-effectiveness) randomized clinical trial was performed in Veterans Affairs clinics across Illinois, Indiana, and Texas from July 1, 2015, to June 30, 2017. Participants included adults with uncontrolled type 2 diabetes (HbA1c level >8.0%) who received primary care during the prior year in participating clinics. Data collection was completed on November 30, 2018, and data analysis was completed on June 30, 2020. All analyses were based on intention to treat. Participants in EPICC attended 6 group sessions based on a collaborative goal-setting theory led by health care professionals. Clinicians conducted individual motivational interviewing sessions after each group. Usual care was enhanced (EUC) with diabetes education. The primary outcome consisted of changes in HbA1c levels after the intervention and during maintenance. Secondary outcomes included the Diabetes Distress Scale (DDS), Morisky Medication Adherence Scale, and Lorig Self-efficacy Scale. Secondary implementation outcomes included reach, adoption, and implementation (number of sessions attended per patient). A total of 280 participants with type 2 diabetes (mean [SD] age, 67.2 [8.4] years; 264 men [94.3]; 134 non-Hispanic White individuals [47.9%]) were equally randomized to EPICC or EUC. Participants receiving EPICC had significant postintervention improvements in HbA1c levels (F1, 252 = 9.12, Cohen d = 0.36 [95% CI, 0.12-0.59]; P = .003) and DDS (F1, 245 = 9.06, Cohen d = 0.37 [95% CI, 0.13-0.60]; P = .003) compared with EUC. During maintenance, differences between the EUC and EPICC groups remained significant for DDS score (F1, 245 = 8.94, Cohen d = 0.36 [95% CI, 0.12-0.59]; P = .003) but not for HbA1c levels (F1, 252 = 0.29, Cohen d = 0.06 [95% CI, -0.17 to 0.30]; P = .60). Improvements in DDS scores were modest. There were no differences between EPICC and EUC in improvements after intervention or maintenance for either adherence or self-efficacy. Among all 4002 eligible patients, 280 (7.0%) enrolled in the study (reach). Each clinic conducted all planned EPICC sessions and cohorts (100% adoption). The EPICC group participants attended a mean (SD) of 4.34 (1.98) sessions, with 54 (38.6%) receiving all 6 sessions. A patient-empowerment approach using longitudinal collaborative goal setting and motivational interviewing is feasible in primary care. Improvements in HbA1c levels after the intervention were not sustained after maintenance. Modest improvements in diabetes-associated distress after the intervention were sustained after maintenance. Innovations to expand reach (eg, telemedicine-enabled shared appointments) and sustainability are needed. ClinicalTrials.gov Identifier: NCT01876485.

Impact of flash glucose monitoring on quality of life and glycaemic control parameters in adults with type 1 diabetes mellitus⋆

IntroductionFlash glucose monitoring (FGM) improves some glycaemic control variables and quality of life parameters. ObjectiveOur aim was to evaluate the quality of life and glycaemic control parameters after initiating FGM in patients with type 1 diabetes (DM1) in clinical practice. Material and methodsA prospective observational study in DM1 patients that started using FGM between June 2019 and April 2020. We analysed their scores on the Diabetes Quality of Life (DQOL) questionnaire, Diabetes Distress Scale (DDS), Diabetes Treatment Satisfaction Questionnaire (DTSQ) and glycaemic control parameters at baseline and 3 months after the FGM onset. ResultsWe recruited 114 patients, 56% male, mean age 37.2 (standard deviation, SD 12.4), with 18.7 (SD 11.5) years of DM1, 24.6% of which used continuous subcutaneous insulin infusion. Differences were observed (baseline vs. 3 months) in the DTSQ score (22 [15.5-27] vs. 25 [22-28], P < 0.001) and in the DQOL score (88 [74-104] vs. 84 [70-101], P = 0.017) but not in the DDS score. HbA1c was 7.8% (SD 1.3) vs. 7.4% (SD 1.1) (P < 0.001), without improvement in other glycaemic control variables, except for the mean number of hypoglycaemic events/14 days: 14 (SD 9) at baseline vs. 11.5 (SD 7) at 3 months (P < 0.001). ConclusionsThe initiation of FGM, combined with a structured educational programme, was associated with improvement in quality of life and patient satisfaction in DM1 patients. An improvement in HbA1c and a reduction in the number of hypoglycaemia events was observed, but not in the rest of glycaemic control parameters.

Diabetic distress and work-related stress among individuals with type 2 diabetes mellitus

Background: Work-related diabetes distress was a term introduced in the context of type 1 diabetes mellitus (T1DM). Currently, there are no studies evaluating the contribution of work-related stress to overall diabetes distress among employed persons with type 2 diabetes mellitus (T2DM). Methods: Adult patients over the age of 21 years with T2DM in full-time employment for over a year were interviewed after informed consent. Diabetes distress was identified with the 17-question diabetes distress scale (DDS) and work-related stress was evaluated using the Siegrist effort-reward imbalance (ERI) questionnaire. DDS scores ≥ 3.0 were considered significant diabetes distress and effort-reward ratio &gt; 1.0 was considered indicative of work stress. Results: One hundred and thirteen patients consented. 68/133 (51.2%) had clinically significant diabetes distress. Work-related stress was seen in 67/113 (50.3%) of patients. Prevalence of work stress was higher among those with clinically significant diabetes distress (62%) compared to those without diabetes distress (38%) (p-value = 0.007). Spearman’s Rho correlation between diabetic distress and effort-reward imbalance was found to be moderately positively correlated (rs = 0.27 [2 tailed] p =.002). Conclusions: Increased work stress that manifests as an imbalance between effort and reward is associated with increased diabetes distress among employed persons with T2DM. The measure of diabetes distress needs to include work stress as a component to complete the picture.

Depression, anxiety, and diabetes-related distress in type 2 diabetes in primary care in Greece: Different roles for glycemic control and self-care.

Objectives:The psychological distress of people living with diabetes is increased and associated with poorer glycemic outcomes and self-care. We aimed to examine the frequency of depression, anxiety, and diabetes-related distress (DRD) of individuals with type 2 diabetes (T2D) in primary care (PC) and their comparative associations with clinical, self-care, and socio-demographic characteristics, testing for possible different roles on glycemic control and self-care.Methods:This is a cross-sectional study of 182 adults with a T2D diagnosis of at least six months, recruited between August 2019-March 2020 and May-October 2020, from an urban PC unit. Participants were screened for symptoms of depression (Patient Health Questionnaire-9 (PHQ-9)), anxiety (Generalized Anxiety Disorder-7 (GAD-7)), and DRD (Diabetes Distress Scale (DDS)). Clinical, self-care, and socio-demographic parameters were recorded.Results:The frequency of clinically significant symptoms of depression was 16.6%, (PHQ-9 score ⩾10), anxiety 17.7% (GAD-7 score ⩾10), and DRD 22.6% (DDS score ⩾2). All PHQ-9, GAD-7, and DDS scores intercorrelated, and higher scores were found to be associated with female gender, lower income, and prior diagnosis of depression. Higher PHQ-9 and GAD-7 scores were found to be associated with lower education, more hypoglycemia episodes, more blood glucose self-tests and antidepressant or benzodiazepine use. The retired/housewives scored significantly lower in GAD-7 and DDS compared to the unemployed participants. Higher DDS scores were associated with higher glycated hemoglobin, higher fasting plasma glucose, and insulin use. It was also noted that higher PHQ-9 scores were associated with lower uric acid levels and were significantly higher in the sedentary lifestyle group.Conclusion:DRD was associated with poorer glycemic outcomes while depressive symptoms were associated with lower physical activity perhaps sharing different roles for glycemic control and self-care. The psychological burden of individuals with T2D may be considered in PC.

Impacto del inicio de la monitorización flash de glucosa en la calidad de vida y en los parámetros de control glucémico de pacientes adultos con diabetes tipo 1

IntroductionFlash glucose monitoring (FGM) improves some glycaemic control variables and quality of life parameters. ObjectiveOur aim was to evaluate the quality of life and glycaemic control parameters after initiating FGM in patients with type 1 diabetes (DM1) in clinical practice. Material and methodsA prospective observational study in DM1 patients that started using FGM between June 2019 and April 2020. We analysed their scores on the Diabetes Quality of Life (DQOL) questionnaire, Diabetes Distress Scale (DDS), Diabetes Treatment Satisfaction Questionnaire (DTSQ) and glycaemic control parameters at baseline and 3months after the FGM onset. ResultsWe recruited 114 patients, 56% male, mean age 37.2 (standard deviation, SD 12.4), with 18.7 (SD 11.5) years of DM1, 24.6% of which used continuous subcutaneous insulin infusion. Differences were observed (baseline vs. 3 months) in the DTSQ score (22 [15.5-27] vs. 25 [22-28], P<0.001) and in the DQOL score (88 [74-104] vs. 84 [70-101], P=0.017) but not in the DDS score. HbA1c was 7.8% (SD 1.3) vs. 7.4% (SD 1.1) (P<0.001), without improvement in other glycaemic control variables, except for the mean number of hypoglycaemic events/14 days: 14 (SD 9) at baseline vs. 11.5 (SD 7) at 3 months (P<0.001). ConclusionsThe initiation of FGM, combined with a structured educational programme, was associated with improvement in quality of life and patient satisfaction in DM1 patients. An improvement in HbA1c and a reduction in the number of hypoglycaemia events was observed, but not in the rest of glycaemic control parameters.

The Impact of Diabetes Distress on the Glycemic Control Among Adolescents and Youth With Type 1 Diabetes in Two Tertiary Centers, Jeddah, Saudi Arabia

IntroductionAdolescents with type 1 diabetes (T1D) experience multiple symptoms of diabetes distress including fear of acute complications such as severe hypoglycemia which may lead to permanent brain damage or death. They also experience fear of acute hyperglycemia that can lead to diabetic ketoacidosis as well as chronic complication including diabetic nephropathy and retinopathy. No previous research was conducted in Saudi Arabia to assess diabetes distress among adolescents and youth with T1D. This study aimed to assess diabetes distress in adolescents and youth with T1D and its relation to clinical characteristics, glycemic control and diabetes co-morbidities.MethodologyA cross-sectional study was conducted on 158 patients at King Abdulaziz University Hospital and Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia. Data about participants’ characters, episodes of DKA, last HbA1c level, diabetes co-morbidities were collected. Diabetes distress (DD) was assessed by the Problem Areas in Diabetes (PAID) and Diabetes Distress Scale (DDS) scores.ResultsThe prevalence of diabetes distress among our population of adolescents with T1D was 24.1%. The mean scores of PAID and DDS were 43.56 ± 13.84 and 2.22 ± 1.05, respectively. Patients with suboptimal HbA1c had significantly higher mean PAID and DDS scores. There is also a significant positive correlation between HbA1c level and number of ketoacidosis episodes. A highly significant positive correlation was found between PAID and DDS scores.ConclusionThis study found that participants with uncontrolled HbA1c had significantly higher mean PAID and DDS scores with a significant positive correlation between the last HbA1c measured level and number of ketoacidosis attacks and PAID and DDS scores. Future studies on larger samples are needed to implement interventions to minimize the burden of diabetes distress among adolescents with T1D.

Diabetes distress and glycaemic control in young adults with type 1 diabetes: Associations by use of insulin pumps and continuous glucose monitors.

We determined whether high diabetes distress (DD) in young adults with type 1 diabetes was associated with higher glycated haemoglobin (HbA1c ) levels and whether this association was similar among those who were and were not using diabetes devices (insulin pumps and/or continuous glucose monitors [CGMs]). In 2017, an online survey was completed by 423 of 743 (57%) young adults (19-31years) with type 1 diabetes receiving care at a specialty clinic in New York City. HbA1c level was the primary outcome measure, and high DD (Diabetes Distress Scale score ≥3) was the primary exposure. Associations were adjusted for sociodemographic covariates. Of the 419 respondents with complete DD data, 59% were female and 69% were non-Hispanic white. Both devices (pump and CGM) were used by 35%, either device by 42% and neither device by 24%. The mean (SD) HbA1c was 64 (19)mmol/mol (8.0 [1.7] %) and 24% had high DD. The adjusted mean (95% confidence interval) HbA1c was 10 (6, 14)mmol/mol (0.9 [0.5, 1.2] %) greater in those with high DD than in those without it. This HbA1c difference associated with high DD was similar regardless of device use: 9 (3, 15)mmol/mol (0.8 [0.3, 1.4] %) greater among those using both devices; and 9 (-0.9, 18)mmol/mol (0.8 [-0.1, 1.7] %) greater among those using neither device. High DD in young adults requires more attention because it is associated with higher HbA1c levels, even among those using insulin pumps and CGMs.

584-P: Diabetes Distress, Depressive Symptoms, and Gender Disparities in Glycemic Control among African Americans with Type 2 Diabetes

Despite advances in diabetes self-management education and support (DSMES), disparities persist in clinical, behavioral, and psychosocial outcomes. Evidence suggests that, in addition to racial/ethnic disparities in diabetes self-management, gender disparities in glycemic control (A1c) exist in patients with type 2 diabetes (T2D). However, there is a knowledge gap in determining if gender differences in A1c are mediated by Diabetes Distress (DD) and/or Depressive Symptoms (DS), or if gender moderates this relationship. Therefore, we aimed to investigate the relationship between gender, DD, DS, and A1c in 94 African American adults with T2D from 9 churches in metro-Detroit, MI. All churches participated in a 15-month, cluster randomized controlled trial focused on DSMS efforts to maintain T2D outcomes following DSME. DD was defined as DD Scale score &amp;gt;=3. DS was measured with the PHQ-9. PHQ-9 was categorized into no DS (PHQ-9 score &amp;lt; 5), minimal DS (PHQ-9 score &amp;gt;=5&amp;lt;10), and depression (PHQ-9 scores &amp;gt;=10). Participants were 44% male, had a mean age of 65.0±10.46 years, and 32% were prescribed insulin. Mean baseline A1c was 7.1±1.7 (males: 7.4±2.0; females: 6.9±1.5, p=0.78). 34.4% of participants reported having DD. More females (35%) reported DD compared to males (31.2%) p=0.72. Approximately 63% of participants reported no DS, 21% reported minimal DS, and 16% reported having DS. There were no differences in PHQ-9 scores when stratified by gender (p=0.17). Mixed effects logistic regression revealed that gender did not moderate the relationship between DD or DS and A1c. However, DD mediated gender differences in A1c (β=-1.7, p=0.02) but DS did not (β=-0.25, p=0.76). Gender differences in a1c for patients with T2D may be attributable to DD, but not DS. As females traditionally report higher DD levels than males and a1c is often worse in males than females, increased attention to these gender differences is warranted, particularly among African Americans. Disclosure J. M. Hawkins: None. N. J. Koscielniak: None. R. Nwankwo: None. M. M. Funnell: Other Relationship; Self; American Diabetes Association. K. A. Kloss: None. D. Hall: None. G. Piatt: None. Funding National Institutes of Health (5R01DK10473305)

529-P: Diabetes-Related Distress in Young Adults Prior to and During the COVID-19 Pandemic: Retrospective Self-Reported Data

Objective: To assess diabetes-related distress in young adults with diabetes in the context of the COVID-19 pandemic.Method: Young adults were recruited through the College Diabetes Network community. Participants completed the validated, 4-item, short-form Diabetes Distress Scale (DDS) virtually, using two recall periods: ‘during the past month’ and ‘prior to the pandemic’. Paired-samples t-tests and Pearson’s correlations were used for analyses.Results: The survey was completed by 375 participants (mean age 22.4±3.2 years, 79% female) in October 2020. Total DDS scores and individual items were significantly higher at the time of the survey compared to prior to the pandemic (all p<.001; see figure below). Additionally, 46% of participants retrospectively endorsed a score above the cutoff for high distress prior to the pandemic, while 54% endorsed a score above the cutoff in the last month. High diabetes distress in the past month was associated with higher self-reported HbA1c (r=.25, p<.001).Conclusions: Young adults report their diabetes distress has increased during the COVID-19 pandemic, highlighting the importance of mental health support for young adults with diabetes during this time. Future work should utilize longitudinal methods to further assess the impacts of the COVID-19 pandemic on diabetes-related distress.View largeDownload slideView largeDownload slide DisclosureD. St. pierre: None. P. V. Commissariat: None. A. Sabino: None. S. Lee: None. J. Saylor: None.

Use of patient-reported outcome measures (PROMs) in clinical diabetes consultations: the DiaPROM randomised controlled pilot trial

ObjectiveTo pilot test the proposed DiaPROM trial components and address uncertainties associated with conducting a full-scale randomised controlled trial (RCT) to evaluate whether such a trial is feasible.DesignTwo-arm pilot RCT.ParticipantsAdults...

Impact of technology use in type 2 diabetes distress: A systematic review.

BACKGROUNDDiabetes distress is an important factor in treatment outcomes and results in poor behavioral and biological consequences. Technology has been used in management programs of diabetes to improve communication between patients and health care providers and to promote education about the disease and its psychological aspects, which can impact the self-efficacy of the programs. However, the true impact of technological approaches on the management of type 2 diabetes distress remains controversial.AIMTo investigate the effectiveness of technology interventions on the management of type 2 diabetes distress.METHODSStudies published from 2014 to 2019 were searched in five databases: MEDLINE, PubMed, Library and Information Science Source, Academic Search Ultimate and PsycINFO. The Boolean logic search terms were: (1) T2Diabetes; (2) diabetes distress; and (3) technology OR mobile OR phone OR application OR web. We also systematically searched the reference lists of the included studies and relevant reviews. Randomized controlled trials with technology interventions, type 2 diabetes patients and diabetes distress as the outcome were selected. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed.RESULTSOf the 88 studies selected, nine full articles met the inclusion criteria and were subjected to final careful review. On the JADAD scale, one article was classified as having poor quality and eight as having good quality. Six out of nine articles showed that technology interventions had a positive impact on diabetes distress scale scores when compared with the initial data. Among the six articles, five showed a greater reduction in the diabetes distress scores from control interventions. Web-based interventions had good results when users received personalized feedback and routine caregiver support and attention.CONCLUSIONTechnology interventions can contribute positively to the management of type 2 diabetes distress, especially with a tailored approach in conjunction with caregiver interaction with patients.

Assessing Diabetes Distress and Sleep Quality in Young Adults with Type 1 Diabetes Using FreeStyle Libre: A Prospective Cohort Study.

IntroductionThe burden of diabetes, its potential complications, and related self-care activities can induce negative psychosocial effects in patients with type 1 diabetes mellitus (T1DM). This prospective cohort study investigated the psychosocial benefits associated with 3 months of FreeStyle Libre (FSL) flash glucose monitoring use in young adults with T1DM in Saudi Arabia.MethodsPatients completed the Diabetes Distress Scale (DDS) and the Pittsburgh Sleep Quality Index (PSQI) questionnaires at baseline and 3 months. HbA1c, number of confirmed hypoglycemia episodes per month, and frequency of blood glucose testing were also collected at baseline and 3 months.ResultsOf 95 patients analyzed, significant reductions were observed in mean DDS (3.8 vs. 2.5; p < 0.001) and PSQI (8.7 vs. 3.9; p < 0.001) scores from baseline to 3 months. Furthermore, HbA1c and confirmed hypoglycemia episodes per month also decreased from baseline to 3 months (HbA1c 8.3 vs. 7.7% [67 vs. 61 mmol/mol], p < 0.001; hypoglycemia episodes 3.0 vs. 2.3, p < 0.001). In contrast, mean frequency of blood glucose testing per day increased from baseline to 3 months (2.5 vs. 5.2; p < 0.001).ConclusionThese data demonstrate improvements in diabetes distress and sleep quality as well as glycemic outcomes following 3 months’ FSL use in young adults with T1DM.

Empowering patients in chronic care to improve diabetes distress and glycaemic control: Protocol for a hybrid implementation-effectiveness clinical trial.

ObjectivesTo evaluate the effectiveness of a collaborative goal‐setting intervention (Empowering Patients in Chronic Care [EPIC]) to improve glycaemic control and diabetesrelated distress, and implementation into routine care across multiple primary care clinics.DesignRandomized controlled trial comparing the effectiveness of the EPIC intervention with enhanced usual care (EUC) at five clinic sites located in the greater Chicago and Houston areas. We will measure differences in haemoglobin A1c (HbA1c) and diabetes distress scale scores among study arms at post‐intervention and maintenance (6 months post‐intervention). We will evaluate implementation of the intervention across sites using the RE‐AIM framework. We will evaluate reach by comparing the per cent and characteristics of enrolled study participants among all potentially eligible participants in the given clinic population. Adoption is reflected by the characteristics of the involved providers and the number of intervention sessions conducted. Implementation of EPIC will be evaluated by number of sessions delivered, participants' evaluation of group sessions, and evaluation of quality of goal‐setting.PatientsWe randomized 280 participants with equal allocation to EPIC and enhanced usual care (EUC).ResultsAt baseline, the groups were similar with the exception that EUC participants were more likely to have prior diabetes education. At baseline, participants were predominately older men who have poorly controlled diabetes (mean HbA1c = 76 mmol/mol [9.1%]) and moderate levels of diabetes distress (mean DDS = 2.43).ConclusionsThis hybrid effectiveness‐implementation protocol is designed to accelerate the translation of a patient‐centred diabetes care intervention from research to clinical practice.