Diabetes Distress Scale Research Articles

Assessment of diabetes-related distress among type 2 diabetic patients, Riyadh, Saudi Arabia.

Objectives:To assess the prevalence of diabetes-related distress (DRD) among Type 2 diabetics in the diabetic center of King Salman Hospital, Riyadh, Saudi Arabia.Methods:This was an observational descriptive study conducted between December 2019 and January 2020 among T2DM patients followed up at the diabetic clinics of the Diabetic Center of King Salman Hospital in Riyadh, Saudi Arabia. We used the 17-items Diabetes Distress Scale (DDS17) to measure DRD.Results:A total of 399 T2DM patients were included in the study, 58.4% were males. High distress was seen in 40 patients. Multivariate analysis showed that longer duration of diabetes (>15 years), female gender, longer intervals in-between visits (>6 months), and experience of episodes of severe hypoglycemia as the most significant factors related to higher levels of distress. The patients who were diabetics longer than 15 years had an increased risk for high distress by 3.6 times, infrequent clinic visits (longer than 6 months) increased the risk for high distress by 5.3 times×, and patients who experienced severe hypoglycemia had an increased risk for high distress by 5.8 times.Conclusion:This study showed a high (35.6%) prevalence of moderate to severe DRD. Long-standing diabetes, a longer interval of a clinic visit, and severe hypoglycemia increase the risk for DRD by 3.6, 5.3, and 5.8 folds. Health care providers should focus on reducing DRD and devise ways to increase self-care practices and coping skills.

Effect of structured education program on physiological and psychosocial outcomes in type 2 diabetes patients: A randomized controlled trial

Objective: This study was conducted to compare the effect of structured education program versus traditional diabetes education on insulin injection technique as well as physiologically and psychosocially related outcomes in adults with Type 2 diabetes.Materials and Methods: This study was a randomized controlled trial. Totally, 71 Type 2 diabetes patients of using the insulin pen were enrolled and randomly divided into the intervention group (n = 36) and the control group (n = 35) according to random number table method. Patients in the intervention group received structured education program, while patients in the control group received traditional diabetes education. The levels of glycosylated hemoglobin (HbA1c), blood glucose, and lipids were monitored before and 3 months after intervention, and the insulin injection techniques, diabetes distress, and diabetes self-management skills between groups were assessed after 3 months.Results: Finally, 65 participants (intervention group: n = 33, control group: n = 32) finished the study. After the intervention, HbA1c was lower (7.42 ± 0.80 vs. 8.35 ± 1.40, P = 0.002), fasting blood glucose (FBG) was lower (7.27 ± 1.06 vs. 9.40 ± 3.16, P < 0.001), and postprandial blood glucose (PBG) was lower (10.33 ± 2.20 vs. 12.77 ± 4.94, P = 0.012) in the intervention group than in the control group. No statistically significance was identified between the two groups in scores of Diabetes Distress Scale and summary of diabetes self-care activities.Conclusion: Patients with Type 2 diabetes received structured education program, with greater improvements achieved in HbA1c, FBG, PBG, and measures about insulin injection techniques compared to the traditional education group, but there was no significant difference in diabetes distress or self-management behavior between groups.

The buffering effect of social support on diabetes distress and depressive symptoms in adults with Type 1 and Type 2 diabetes.

Social support may buffer or decrease the negative effects of diabetes distress (DD) and depressive symptoms on diabetes outcomes. We assessed the buffering role of social support in the relationship between DD and self-care and depressive symptoms and self-care in adults with Type 1 (T1D) and Type 2 (T2D) diabetes. Participants completed the Diabetes Distress Scale for T2D or T1D, the Patient Health Questionnaire-9, the Medical Outcomes Study Social Support Survey and the Self-Care Inventory-Revised. We conducted hierarchical multiple regression models using SPSS version 26.0. A total of 325 adults (median age=40.5 years, 62.2% women, 86.5% White; 59.7% T2D, A1C=59±6 mmol/mol or 7.5±1.6%; median duration=11.0years) participated. Greater social support buffered the negative effects of DD on self-care (R2 Δ=0.015, p=0.024) as well as depressive symptoms on self-care (R2 Δ=0.024, p=0.004) in participants with T1D and T2D. Both regression models recorded medium effect sizes (F2 =0.220, F2 =0.234 respectively). Social support subscale analyses showed tangible support (R2 Δ=0.016, p=0.018) and affectionate support (R2 Δ=0.016, p=0.020) buffered DD and self-care, and emotional support (R2 Δ=0.015, p=0.022), tangible support (R2 Δ=0.020, p=0.009), affectionate support (R2 Δ=0.025, p=0.004) and positive interaction support (R2 Δ=0.017, p=0.018) buffered depressive symptoms and self-care. Findings suggest that social support buffers the impact of DD and depressive symptoms on self-care in adults with T1D and T2D. Additional research is needed to confirm the buffering role of social support on DD and depressive symptoms. Greater understanding of these interactions may help improve clinical care and outcomes.

Age differences in reactivity to daily general and Type 1 diabetes stressors.

Older adults often report less exposure to and less affective reactions to daily stressors. However, older adults with a chronic illness such as Type 1 diabetes may experience more daily stressors due to the complications of diabetes and may be more affected by those stressors. The study examined (a) age differences in reported exposure to general and diabetes stressors, (b) whether daily general and diabetes stressors relate to daily positive and negative affect, self-care, and blood glucose, and (c) whether these daily associations are moderated by age and comorbidity. Individuals with Type 1 diabetes (n = 199; 52.3% female, average age 46.81 years) completed a checklist for 14 days reporting general and diabetes stressors. General diabetes distress was assessed with the Diabetes Distress Scale. Daily positive and negative affect and daily self-care behaviors were rated each day. Blood glucose was assessed via glucometers. Older adults reported fewer daily general and diabetes stressors and less diabetes distress compared to younger adults. Multilevel models indicated that both daily general and diabetes stressors (between- and within-person) were associated with lower positive and higher negative affect. Fewer diabetes stressors were associated with better self-care and lower (better) mean blood glucose. Neither age nor comorbidity interacted with general or diabetes stressors to predict any outcome (except one effect for comorbidity), indicating that older adults and those experiencing more comorbid conditions were similarly affected by stressors. Results suggest that older adults experience fewer stressors than younger adults but are similarly affected when stressors do occur. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Managing Depression in Diabetes Mellitus: A Multicentric Randomized Controlled Trial Comparing Effectiveness of Fluoxetine and Mindfulness in Primary Care: Protocol for DIAbetes Mellitus ANd Depression (DIAMAND) Study.

Background:Suboptimal management of depression in type 2 diabetes mellitus (T2DM) often translates into poor glycemic control, medical complications, and impaired quality of life. Feasibility and effectiveness of collaborative care models of depression in diabetes in low- and middle-income countries (LMICs) remain unexplored. DIAbetes Mellitus ANd Depression (DIAMAND) study, a multicentric single-blind randomized controlled trial (SBRCT) comparing effectiveness of fluoxetine and mindfulness in primary care settings, addresses this gap in scientific literature.Methods:This trial conducted in diverse geographic settings of New Delhi, Bengaluru, and Bhubaneswar will comprise module-based training of primary care providers (PCPs) for screening, diagnosing, and managing depression in diabetes in phase I. Phase II will involve four-arm parallel group RCT on 350 participants with T2DM with comorbid depressive episode randomly allocated to receive fluoxetine, mindfulness therapy, fluoxetine plus mindfulness therapy, or treatment as usual at primary care settings. Interventions would include fluoxetine (up to 60 mg/day) and/or sessions of mindfulness for 16 weeks. Primary outcomes on standardized rating scales include depression scores (Hamilton Depression Rating Scale), treatment adherence (Adherence to Refill and Medication Scale), self-care (Diabetes Self-Management Questionnaire), diabetes-related distress (Diabetes Distress Scale), and glycemic control. Secondary outcomes include quality of life (World Health Organization Quality of Life Brief version [WHO-QOL BREF]) and mindfulness (Five Facets Mindfulness Questionnaire).Discussion:This RCT will investigate the effectiveness of module-based training of PCPs and feasibility of collaborative care model for managing depression in T2DM in primary care settings in LMICs and effectiveness of fluoxetine and/or mindfulness in improving diverse outcomes of T2DM with major depression.

Diabetes-Related Distress and Its Associated Factors Among Patients with Diabetes in Vietnam.

BackgroundPsychometric properties are regarded as one of the significant contributors related to diabetes treatment efficacy. Diabetes-related distress (DD) is one of the emotional burdens. The aims of this study were to investigate the prevalence of DD and to determine its associated factors among Vietnamese diabetic patients.MethodsA cross-sectional study was conducted at a single medical center in the central of Vietnam. A total of 138 eligible DM outpatients were invited and a total of 112 patients who completed the questionnaire were utilized in this analysis using convenience sampling. DD was assessed using the diabetes distress scale (DDS). The participant’s sociodemographic and clinical information was obtained through face-to-face interviews and medical records. Multivariate logistic regression was used to determine independent factors associated with the presence of DD.ResultsApproximately, 12.5% of the patients experienced DD based on DDS self-administered questionnaire. The rates of mild/moderate and high distress were 8.0% and 4.5%, respectively. DD was found to be significantly higher in type 1 DM (p=0.04), insulin only in treatment regime (p=0.04), physical inactivities (p=0.02), times of mild hypoglycemia (time/month) (p=0.01), and fasting plasma glucose (mmol/l) (p=0.04). The occurrence of distress among DM patients was negatively correlated with their age and amount of physical exercise. Meanwhile, poor HbA1c control (HbA1c≥7%) was associated with an increased occurrence of diabetes distress.ConclusionThe findings of single medical center in Vietnam highlights that DD is prevalent among DM patients. It should be of marked concerns, particularly the type 1 diabetic patients, younger age, and poor glycemic control patients.

A Web-Based Mental Health Intervention to Improve Social and Occupational Functioning in Adults With Type 2 Diabetes (The Springboard Trial): 12-Month Outcomes of a Randomized Controlled Trial.

BackgroundPeople with type 2 diabetes mellitus (T2DM) often experience mental health symptoms that exacerbate illness and increase mortality risk. Access to psychological support is low in people with T2DM. Detection of depression is variable in primary care and can be further hampered by mental health stigma. Electronic mental health (eMH) programs may provide an accessible, private, nonstigmatizing mental health solution for this group.ObjectiveThis study aims to evaluate the efficacy over 12 months of follow-up of an eMH program (myCompass) for improving social and occupational functioning in a community sample of people with T2DM and self-reported mild-to-moderate depressive symptoms. myCompass is a fully automated and self-guided web-based public health program for people with depression or anxiety. The effects of myCompass on depressive symptoms, diabetes-related distress, anxiety symptoms, and self-care behavior were also examined.MethodsAdults with T2DM and mild-to-moderate depressive symptoms (N=780) were recruited via online advertisements, community organizations, and general practices. Screening, consent, and self-report questionnaires were administered online. Eligible participants were randomized to receive either myCompass (n=391) or an attention control generic health literacy program (Healthy Lifestyles; n=379) for 8 weeks. At baseline and at 3, 6, and 12 months postintervention, participants completed the Work and Social Adjustment Scale, the Patient Health Questionnaire-9 item, the Diabetes Distress Scale, the Generalized Anxiety Disorder Questionnaire-7 item, and items from the Self-Management Profile for Type 2 Diabetes. Glycosylated hemoglobin measurements were obtained at baseline and 6 and 12 months postintervention.ResultsA total of 38.9% (304/780) of the trial participants completed all postintervention assessments. myCompass users logged in on an average of 6 times and completed an average of 0.29 modules. Healthy Lifestyles users logged in on an average of 4 times and completed an average of 1.37 modules. At baseline, the mean scores on several outcome measures, including the primary outcome of work and social functioning, were close to the normal range, despite a varied and extensive recruitment process. Intention-to-treat analyses revealed slightly greater improvement at 12 months in work and social functioning for the Healthy Lifestyles group relative to the myCompass group. All participants reported equivalent improvements in depression anxiety, diabetes distress, diabetes self-management, and glycemic control across the trial.ConclusionsThe Healthy Lifestyles group reported higher ratings of social and occupational functioning than the myCompass group, but no differences were observed for any secondary outcome. Although these findings should be interpreted in light of the near-floor symptom scores at baseline, the trial yields important insights into how people with T2DM might be engaged in eMH programs and the challenges of focusing specifically on mental health. Several avenues emerge for continued investigation into how best to deal with the growing mental health burden in adults with T2DM.Trial RegistrationAustralian New Zealand Clinical Trials Registry Number (ACTRN) 12615000931572; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368109&isReview=true

Effects of novel flash glucose monitoring system on glycaemic control in adult patients with type 1 diabetes mellitus: protocol of a multicentre randomised controlled trial

IntroductionOptimal glycaemic control is beneficial to prevent and delay microvascular complications in patients with type 1 diabetes mellitus (T1DM). The benefits of flash glucose monitoring (FGM) have been proved among...

A Proof of Concept Study to Evaluate the Impact of an Established Telehealth Mood Monitoring System on Mood in Individuals with Type 2 Diabetes when Initiating an Injectable Therapy

Background: We aimed to determine the feasibility of using an established telehealth system to monitor potential mood changes in individuals with type 2 diabetes when commencing an injectable glucose-lowering therapy. Methods: Individuals with type 2 diabetes commencing an injectable therapy as part of their routine clinical care when not achieving glycemic control on oral antidiabetic therapy, or when instituted as part of a randomized clinical trial, were asked to self monitor their mood for six months. Participants were asked to complete the Quick Inventory of Depressive Symptoms–Self Report (QIDS-SR) weekly and the Diabetes Distress Scale (DDS17) monthly. Results: Seven participants were recruited who all initiated an injectable therapy and were followed up for median 33 (27–37) weeks. Median (IQR) proportions of returned QIDS-SR and DDS17 questionnaires were 100% (86%–100%) and 100% (100%–100%) respectively, with completeness 88% (80%–100%) and 100% (100%–100%). DDS17 scores increased (worsened) during the first month after injectable therapy initiation, followed by a gradual decline in QIDS-SR scores and stabilizing DDS17 responses. Conclusion: We show that an online self-management system can be used to monitor mood remotely in type 2 diabetes population, and could provide additional metrics to help inform diabetes management.

A comparison of self-care activities and diabetes distress among type II diabetic patients in urban and rural field practice area: a cross-sectional study

Background: Diabetes is a challenging disease that is considered to be hard to live with as it encompasses a lot of restrictive instructions. Self-care diabetes has been defined as an evolutionary process of development of knowledge or awareness by learning to survive with the complex nature of diabetes. Diabetic distress refer to an emotional state where people experience feelings such as stress, guilt or denial that arise from the living with diabetes and the burden of self-management. The emotional distress facing people with diabetes due to such life style restriction. The objectives were to evaluate self-care activities related to diabetes among type II diabetic patients using diabetes self-management questionnaire and to assess and compare the diabetes distress score using diabetes distress scale among urban and rural type II diabetic patient.Methods: A cross-sectional study was conducted in 140 urban and 70 rural study participants in field practice area of SNMC, Bagalkot. Diabetic self-care activities and diabetic distress were analyzed.Results: Our study showed most of the study participants had poor self-care activities. Our study showed 60% of rural participants screen positive for moderate diabetic distress where as 52.1% of urban participants showed positive for high diabetic distress.Conclusions: To combat the stress associated with diabetes, it is important to educate the patient to adapt with change in their life style following the diagnosis of diabetes.

Subjective cognitive decline in diabetes: Associations with psychological, sleep, and diabetes-related factors.

To determine whether psychological, sleep, and diabetes-related factors were associated with subjective cognitive decline (SCD) in adults with type 2 diabetes (T2D). A secondary analysis with a cross-sectional, correlational design. Data from two parent studies were combined. A total of 105 adults with diabetes were recruited from a Midwestern city in the United States from September 2013-March 2014 and September 2016-September 2017. Subjective cognitive decline was measured with the psychological-cognitive symptom subscale of the Diabetes Symptom Checklist-Revised. Psychological factors (diabetes distress, fatigue, and depressive symptoms) and sleep were measured using the Diabetes Distress Scale and Patient-Reported Outcomes Measurement Information System. Diabetes-related factors were measured with body mass index and glycaemia control. Quantile regression was used to examine the associations. The mean age of the participants was 58.10 (SD 7.92) years and 58.1% were women. The participants' mean psychological-cognitive symptom score was 1.41 (SD 1.13). After controlling for age and gender, sleep disturbance, sleep-related impairment, and body mass index were associated with SCD in lower cognitive symptom quantile groups (5th to 30th percentiles). In contrast, fatigue and depressive symptoms were more strongly associated with SCD in higher quantile groups (70th to 95th percentiles). In adults with T2D, SCD was differentially associated with psychological, sleep, and diabetes-related factors depending on cognitive symptom percentiles. Adults with T2D require regular screening for SCD. If they complain of cognitive symptoms at clinical visits, different underlying factors should be assessed according to their symptom severity. Findings from this study provided evidence for early identification of SCD and its influencing factors, which may help to develop nursing interventions to recognize and/or delay the onset of cognitive impairment in adults with T2D.

Occupational balance in people with type-2 diabetes: A comparative cross-sectional study

Introduction Diabetes mellitus may negatively impact individuals’ occupational balance. This study seeks to compare occupational balance in people with and without diabetes and also explore the biological and psychological factors associated with occupational balance in people with diabetes. Method This comparative cross-sectional study was conducted using simple non-probability sampling. Participants’ occupational balance was evaluated by the Life Balance Inventory. Blood samples were taken from those with diabetes and analyzed. Psychological distress was also evaluated in the people with diabetes using the Diabetes Distress Scale. Results A total of 160 individuals, including 80 people with diabetes and 80 people without diabetes, participated in this study. The mean occupational balance scores for people with and without diabetes were 2.56 and 2.61, respectively. There was no significant difference between the groups in occupational balance. Distress was the only significant factor related to occupational balance in people with diabetes ( p &lt; 0.05). Conclusion Distress was the only bio-psychological factor associated with occupational balance in people with diabetes. A higher level of distress is associated with lower occupational balance and also poor glycemic control in this population.

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.

Internal structure and psychometric properties of Diabetes Distress Scale for Type 1 Diabetes.

Diabetes-related distress (DD) refers to the worries and concerns about the nature and complications of Type 1 diabetes (T1D) and the frustration with the burdens of its management. Research suggests that sources of DD among people with T1D differ from those among Type 2. Many adults with T1D experience difficulties that are often unrecognised, unaddressed and mismanaged. The Diabetes Distress Scale for Type 1 diabetes (T1-DDS), is a newly developed instrument that is used to identify the specific sources of DD, exclusively for adults with T1D. The aim of the study was to examine the factorial structure of T1-DDS in Greek population and to evaluate its psychometric properties for use in research and clinical practice. A sample of 102 adults with type 1 diabetes, aged 38.85 (±10.08) years, females 63%, BMI 21.45 (±5.84) kg/m2, diabetes duration 21.35 (±13.73) years, HbA1c 7.5% (±1.2;58 mmol/mol) completed the translated T1-DDS. Exploratory factor analysis (EFA) and confirmatory (CFA) factor analysis were used to investigate the factor structure of the scale. Reliability was explored by internal consistency. Convergent validity was assessed through correlations with measures of psychological distress and diabetes status variables. Differential validity was assessed on the basis of known-group comparisons, with expected differences in distress for gender and age. Confirmatory factor analysis provided a low fit for the 7-factor model. Exploratory factor analysis supported a conceptually justifiable 5-factor model in the Greek sample. Internal consistencies of all five factors ranged from α=0.76 to 0.89. As expected, all factors were correlated with psychological distress [(r=0.510, p<0.01) for the total scale]. Management distress was positively correlated with HbA1c (r=0.397, p<0.01) and BMI (r=0.296, p<0.01), and Family/Friends distress was negatively correlated with duration of diabetes (r=-0.298, p<0.01). Further analyses showed that men exhibited higher score in relations to the social context of diabetes management (t=2.164, p<0.05 for Negative Social Perceptions), (t=2.572, p<0.05 for Family/Friends distress), and younger participants reported significantly higher distress in relation to reactions from friends and family (t=2.106, p<0.05). The Greek version of T1-DDS is a valid and reliable measure of diabetes-related distress that can be used in clinical practice to address personal needs and direct targeted interventions.

Diabetes-related distress and daily cortisol output in people with Type 2 diabetes

AimsDiabetes-related distress is common in Type 2 Diabetes and is linked with poor diabetes control. However, mechanisms underlying this association are unclear. One pathway that could be involved is neuroendocrine dysfunction, as Type 2 Diabetes is associated with altered diurnal cortisol output. This study investigated the link between diabetes-related distress and diurnal cortisol output. Methods134 people with Type 2 Diabetes provided 5 cortisol samples over the course of a day. Multivariate linear regression models were used to assess whether overall and sub-domains of diabetes-related distress measured by the Diabetes Distress Scale, predicted cortisol parameters (waking cortisol, cortisol awakening response, cortisol slope and evening cortisol). ResultsPhysician-related distress was associated with greater waking (B = 2.747, p = .015) and evening cortisol (B = 1.375, p = .014), and a blunted cortisol awakening response (B = −3.472, p = .038) adjusting for age, sex, income, body mass index, smoking and time of awakening. No associations were detected for overall distress, emotional, interpersonal or regimen distress. ConclusionPhysician-related distress was associated with alterations in daily cortisol output. Longitudinal research is required to understand how physician-related distress is associated with diurnal cortisol patterning over time.

Diabetes distress is associated with individualized glycemic control in adults with type 2 diabetes mellitus.

It has been proposed that the negative emotional state of diabetes distress (DD) may exert a detrimental effect on glycemic outcomes of individuals struggling with diabetes-related challenges. Thus far, no study has investigated this association by utilizing individualized treatment targets of patients' glycemic control. Therefore, we sought to identify the potential role of DD in the achievement of individualized glycemic targets (AIGTs) among persons with type 2 diabetes mellitus (T2D). This cross-sectional study included a well-characterized outpatient group of T2D adults cared for in an academic medical center. DD was evaluated with the Diabetes Distress Scale. The AIGTs was defined according to the American Diabetes Association guidelines. Logistic regression analyses were utilized to identify independent correlates of the AIGTs. A total of 123 individuals (mean [standard deviation] age: 58.0 [6.2]years, 55.3% females) were included in the final analysis. AIGTs was observed in 43.9% of the patients. Experiencing greater DD was associated with a lower likelihood of AIGTs (unadjusted odds ratio [OR]: 0.17, 95% confidence interval [CI]: 0.08-0.34, P value < 0.001), even after accounting for additional individual-level covariates (adjusted OR: 0.18, 95% CI: 0.08-0.42, P value < 0.001). Medication adherence was also a determinant of participants' AIGTs (adjusted OR: 1.91, 95% CI: 1.13-3.23, P value = 0.015). Our findings provide novel evidence that DD likely undermines glycemic status in adult outpatients with T2D, even in the context of individually tailored diabetes care, and this should be taken into account when necessary.

The Association between Diabetes Complications, Diabetes Distress, and Depressive Symptoms in Patients with Type 2 Diabetes Mellitus.

This study investigated the association between diabetes complications, diabetes distress, and depressive symptoms in patients with type 2 diabetes mellitus. A total of 600 patients with type 2 diabetes mellitus were included in this study. Data were collected using the Diabetes Distress Scale and the nine-item Patient Health Questionnaire. The results showed that both diabetes complications and diabetes distress were positively associated with depressive symptoms, and diabetes distress attenuated the association between diabetes complications and depressive symptoms. The Sobel test confirmed the mediating effect of diabetes distress. Patients with both diabetes complications and diabetes distress had a higher risk of depressive symptoms than those with diabetes complications or diabetes distress alone. This study indicates that the positive association between diabetes complications and depressive symptoms is persistent and mediated by diabetes distress, and the comorbidity of diabetes complications and diabetes distress has an additive interaction effect on depressive symptoms.

Benefits of Brief Group Cognitive Behavioral Therapy in Reducing Diabetes-Related Distress and HbA1c in Uncontrolled Type 2 Diabetes Mellitus Patients in Thailand.

This study evaluated the short-term efficacy of brief group cognitive behavioral therapy (BG-CBT) in reducing diabetes-related distress (DRD), lowering hemoglobin A1c (HbA1c), improving food consumption behavior, increasing physical activity, and improving medication adherence behavior. A quasi-experimental pretest/post-test design with follow-up assessments was used with an experimental and a control group. Participants were patients with uncontrolled type 2 diabetes mellitus (T2DM) and moderate or high diabetes-related distress recruited from the Diabetes Mellitus Clinic of Hang Dong Hospital, Chiang Mai, Thailand. Fifty-six eligible participants were purposively selected and enrolled, then randomly assigned to either the BG-CBT group or the control group. The BG-CBT group received six brief weekly sessions of cognitive behavioral group therapy, while the control group received conventional care. Baseline data were collected at week 0 (pretest) and at week 6 (post-test), including food consumption behavior, physical activity, and adherence to medication regimes, as well as a blood examination to determine levels of HbA1c at the week 12 follow-up. DRD was assessed using the Diabetes Distress Scale (DDS-17) and analyzed using descriptive statistics, including pair t-test and independence t-test results. The BG-CBT had a significant effect on the amelioration of diabetes distress, improvement of food consumption behavior, and reduction of HbA1c levels, demonstrating the effectiveness of BG-CBT in maintaining diabetes control in people with T2DM-related distress.

Improvement in Patient-Reported Outcomes in Adults with Type 1 Diabetes Treated with Sotagliflozin plus Insulin Versus Insulin Alone

Background: Diabetes-related distress is common among persons affected by diabetes and is associated with suboptimal glycemic control and complications, thus constituting a relevant patient-report outcome (PRO). Improving glycemic control may reduce diabetes distress and improve treatment satisfaction. This post hoc analysis evaluated PRO data for a pooled cohort of adults with type 1 diabetes (T1D) receiving sotagliflozin as adjunct to optimized insulin in the inTandem1 and inTandem2 studies. Methods: Clinically meaningful changes in the Diabetes Treatment Satisfaction Questionnaire status version (DTSQs) and the two-item Diabetes Distress Scale (DDS2) total and individual scores were examined in the pooled data from the first 24 weeks of the studies. Results: In the cohort of patients with a baseline DTSQs total score ≤32 (∼76% of entire cohort), nearly twice as many patients treated with sotagliflozin 200 (45.9%) or 400 mg (42.3%) experienced a >3-point improvement from baseline versus those treated with placebo (24%). Treatment with sotagliflozin led to statistically significant (P < 0.05) improvements across all DTSQs items. Approximately 42% of all patients were considered to have a high risk of diabetes distress (total DDS2 score ≥6) at baseline following insulin optimization. More patients shifted from high to low risk with sotagliflozin compared with placebo (∼40% vs. 23%; P ≤ 0.0002). The baseline-adjusted difference in DDS2 from placebo was significantly (P < 0.001) reduced by -0.5 and -0.6 for sotagliflozin 200 and 400 mg, respectively. Conclusions: Patients with T1D treated with sotagliflozin in addition to optimized insulin therapy reported meaningful improvements in treatment satisfaction and diabetes distress. NCT02384941 and NCT02421510.

The Mediating Role of Resilience and Diabetes Distress in Relationship between Depression and Treatment Adherence in Type 2 Diabetes among Iranian Patients

Introduction: The coexistence of mental health problems in diabetic patients can lead to poor disease management, lack of adherence to treatment, and poor quality of life. Therefore, this study aimed at investigating the mediating role of resilience and diabetes distress in the relationship between depression and treatment adherence in type 2 diabetes among Iranian patients. Methods: It is a type of analytical study conducted from 2019 to 2020. The statistical population of this study consisted of all-diabetic patients in Tehran. The subjects (200) were selected after purposeful clinical evaluation and qualification of research. In this study, Beck Depression Inventory (BDI), the Persian Version of the Morisky Medication Adherence Scale-8, Diabetes Distress Scale (DDS), Conner &amp; Davison Resilience Scale (CDRS) were used to collect the data. Pearson correlation test by SPSS version 24 and Confirmatory Factor Analysis in AMOS software version 22 were used for analysis (P&lt;0.05). Results: In the present study, most participants (about 36.5%) were in the age group of 56-65 and 58.5% of them were female. According to the results, the variables of depression and diabetes distress has a negative and significant correlation with adherence to treatment (r= -.408, p&lt;0.05). The resiliency has a positive and significant correlation with adherence to treatment (r= 0.414, p&lt;0.05). The result, by multiplying the two non-standard coefficients that constitute the intermediate variable paths by the standard error of the product, showed depression has an indirect effect on adherence to treatment by mediating the role of resiliency and diabetes distress. Conclusion: The findings showed a link between depression, diabetes pain, endurance, and treatment adherence. Resilience and anxiety from diabetes play a mediating role between depression and adherence to care. Therefore, paying attention to patient resilience may lead to improved depression and diabetes distress in patients with diabetes, and it may be a useful way to increase the patient’s involvement in treatment adherence.