Screening For Diabetes Distress Research Articles

Psychometric properties of the German versions of the Problem Areas in Diabetes Scale for Children (PAID-C) with Type 1 Diabetes and Their Parents (P-PAID-C).

Children with Type 1 diabetes (T1D) and their parent-caregivers often experience diabetes distress due to the daily demands of diabetes management. Regular screening for diabetes distress is needed to prevent the deterioration of metabolic control and the development of mental health disorders. The aim of this analysis was to examine the psychometric properties of the German versions of the Problem Areas in Diabetes Scale for Children (PAID-C) and for caregiver burden in Parents (P-PAID-C). Data were collected from 136 children aged 7-12 years (46.7% females) and 304 parents (Mage = 42.9 (SD 6.1) years; 78% mothers) by using linguistically translated questionnaires in a multicenter study. Confirmatory factor analysis and correlational analyses were conducted. Results confirmed the two-factor model for the PAID-C and the four-factor model for the P-PAID-C with a slight modification. Cronbach's αs for children and parents were 0.88 and 0.92, respectively. The PAID-C and P-PAID-C scores had small positive associations with HbA1c (rs = .220 and .139, respectively, all p < .05) and strong inverse association with the KIDSCREEN-10 index (r = -.643 and -.520, respectively, all p < .001). P-PAID-C scores increased with increasing depressive symptoms measured in nine-item Patient Health Questionnaire among parents (rs = .534, p < .001). The scores produced by the German PAID-C and P-PAID-C were reliable and valid in measuring diabetes burdens. These German versions of PAID can be utilized to assess diabetes-specific distress and to design interventions for children and their parents experiencing high levels of diabetes distress. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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.

Feasibility of caregiver diabetes distress screening in routine clinical care of youth with type 1 diabetes.

Caregiver diabetes distress (DD) consists of feeling overwhelmed, sad, and/or concerned; one-third of parents of youth with type 1 diabetes (T1D) report severe distress up to 4 years after T1D diagnosis. PAID-PR (Problem Areas in Diabetes Survey-Parent Revised) assesses DD primarily in research settings; however, less is known about its clinical utility. We aimed to identify the feasibility of implementing PAID-PR screening at a diverse, academic US paediatric diabetes center during routine clinic follow-up visits through quality improvement methodologies. The PAID-PR was intended to be offered in English to caregivers at all paediatric T1D appointments, by the front desk during appointment check-in, or through REDCap prior to telehealth appointments or at local sites to all eligible caregivers. Adult psychosocial resources were provided to all, regardless of score. Forms were scored after appointments; scores ≥80 were referred to Diabetes Psychology providers for follow-up. A total of 391 caregivers completed the PAID-PR, though only half of eligible caregivers received it in person. Response rates were highest in person (90%), compared to REDCap (25%). In total, 27% (n = 107) scored ≥56 (DD). Of those with DD, 21% (n = 23) scored ≥80 and were referred to psychology. Demographics are reported in Table1. PAID-PR score was positively correlated to A1c (p = 0.038) and inversely to child age (p = 0.014). Clinic caregiver DD screening was implemented with higher response rates in person; however, expanding in-person screening to all eligible caregivers is necessary. Furthermore, since the PAID-PR was in English, some caregivers with DD were likely missed. Future directions include screening in additional languages.

Screening for diabetes distress and depression in routine clinical care for youth with type 1 diabetes.

The purpose of this study is to examine diabetes distress as a potential mediator of the relationship between depression symptoms and diabetes outcomes, including hemoglobin A1c (hemoglobin A1c [HbA1c]) and diabetes management behaviors in a clinical sample of adolescents and young adults. In a pediatric diabetes clinic, 716 youth (ages 12-21 years) completed measures of diabetes distress (Problem Areas in Diabetes-Teen [PAID-T]), a single-item of diabetes distress, and depression (Patient Health Questionnaire [PHQ-9]) as part of standard care. Electronic health records were extracted for the "Six Habits" and glycemic management (HbA1c). Overall, 3.6% (n = 26) of adolescents had clinically elevated diabetes distress and depression symptoms, 5.0% had diabetes distress alone, 8.7% had depression symptoms alone, and 82.7% had neither clinical elevation of diabetes distress nor depression symptoms. Results of mediation analysis demonstrated diabetes distress (both full and single-item measures) fully mediated the relationship between depression symptoms and HbA1c (p < .001). Also, mediation analysis results showcase incomplete mediation of the effect of the Six Habits score on HbA1c appears by PAID-T Diabetes Distress. In a clinical sample of youth with type 1 diabetes, both depressive symptoms and diabetes distress are associated with HbA1c. Furthermore, diabetes distress fully mediates the relationship between depressive symptoms and HbA1c. As part of standard clinical care, the single-item screener for diabetes distress captured similar results as the full-scaled PAID-T. With limited clinical resources, providers may consider focusing assessment and interventions on the psychological factor of diabetes distress within the diabetes clinic to maximize the impact on glycemic control and consider the use of single-item screening to identify distress.

The case for screening for diabetes distress, depression, and anxiety.

Our goal was to determine the prevalence of anxiety and depression in a sample of U.S. military veterans with type 2 diabetes and elevated diabetes distress (DD). Cross-sectional analyses were conducted. The association between DD and anxiety and depression was assessed with logistic regression. Almost 80% of persons with elevated DD had clinically significant anxiety or depression symptoms. The odds of depression and anxiety increased with DD severity. Given the large overlap of depression and anxiety with elevated DD, we recommend providers screen for all three conditions and, if positive, connect to resources for diabetes self-management and/or clinical treatment.

Diabetes distress in urban Black youth with type 1 diabetes and their caregivers: associations with glycemic control, depression, and health behaviors.

Adolescents with type 1 diabetes (T1D) and their caregivers endorse high diabetes distress (DD). Limited studies have documented the impact of DD on Black youth. The aims of the present study were to (1) describe DD among a sample of Black adolescents with T1D and their caregivers, (2) compare their DD levels with published normative samples, and (3) determine how DD relates to glycemic outcomes, diabetes self-management, parental monitoring of diabetes, and youth depressive symptoms. Baseline data from a multicenter clinical trial were used. Participants (N = 155) were recruited from 7 Midwestern pediatric diabetes clinics. Hemoglobin A1c (HbA1c) and measures of DD, parental monitoring of diabetes care, youth depression and diabetes management behaviors were obtained. The sample was split into (1) adolescents (ages 13-14; N = 95) and (2) preadolescents (ages 10-12; N = 60). Analyses utilized Cohen's d effect sizes, Pearson correlations, t-tests, and multiple regression. DD levels in youth and caregivers were high, with 45%-58% exceeding either clinical cutoff scores or validation study sample means. Higher DD in youth and caregivers was associated with higher HbA1c, lower diabetes self-management, and elevated depressive symptoms, but not with parental monitoring of diabetes management. Screening for DD in Black youth with T1D and caregivers is recommended, as are culturally informed interventions that can reduce distress levels and lead to improved health outcomes. More research is needed on how systemic inequities contribute to higher DD in Black youth and the strategies/policy changes needed to reduce these inequities.

Prevalence of Distress among Diagnosed Type 2 Diabetics Residing in Rural and Urban Areas of District Amritsar: A Cross-Sectional Study

Background: Patients with diabetes face psychological issues which may be part of the spectrum of diseaseexperience, distinct from depression, which hinder glycemic control. Therefore, this study was planned todetermine the prevalence of diabetes related distress, and its association with socio-demographic variables,treatment status, and glycemic control in adults with type 2 diabetes.Materials and Methods: A cross-sectional study was conducted among diagnosed type 2 Diabetic patientsresiding in urban and rural field practice area of Government Medical College, Amritsar. Data was collected forperiod of one year. Pre-tested, validated questionnaire Diabetes Distress Screening Scale 17 (DDS17) was used.Quantitative and Qualitative variables were compared using t- test and Chi-square test respectively. P value &lt;0.05was considered to be statistically significant.Results: Overall, 18% of study participants were found to be distressed. Distress was slightly higher among urbanstudy participants (21%) in comparison to rural study participants (15%) but this difference was not statisticallysignificant. Significantly higher distress levels were observed among study participants who reported inadequatetreatment, uncontrolled glycemic status and complications due to diabetes.Conclusions: Diabetes related distress is associated with treatment status, glycemic status and complications dueto diabetes. There is need to manage diabetes well and achieve glycemic control in all patients to reduce level ofdistress among them.

Feasibility and Acceptability of Home-Delivered Medically Tailored Meals for Treatment of Diabetes in Pregnancy

BackgroundDiabetes complicates ≤7% of pregnancies in the United States. Although medical nutrition therapy is the mainstay of diabetes treatment, many barriers exist to the successful implementation of dietary modifications. Home-delivered medically tailored meals (MTMs) are promising to overcome such barriers. ObjectiveThe objective of this study was to evaluate the feasibility and acceptability of home-delivered MTM in pregnant patients with diabetes. MethodsWe performed a prospective cohort study of home-delivered MTM for pregnant patients with diabetes using a mixed-methods approach. Participants <35 wk of gestation at the time of enrollment received weekly home delivery of diabetes-specific meals. Qualitative semistructured interviews were conducted to gain insight into participants’ experience. Diabetes self-efficacy was assessed pre- and postintervention using the Diabetes Self-Efficacy Scale and 2-Item Diabetes Distress Screening Scale. The difference in mean scores was compared using t-tests with P value of <0.05 considered significant. Feasibility and acceptability were evaluated through participants’ attitude toward MTM in qualitative interviews and indirectly evaluated through diabetes self-efficacy surveys. ResultsTwenty pregnant people with diabetes who received home-delivered MTM during pregnancy were interviewed postpartum. Participants found this program convenient for various reasons, including reduced time for grocery shopping and preparing meals. Participants were satisfied with meals, citing a positive impact on diabetes management, accessibility of healthy foods, reduced stress with meal planning, and greater perceived control of blood glucose. Most participants shared meals with their families or received specific meals for their dependents, which was positively received. Reduced financial and mental stress was also widely reported. Diabetes self-efficacy was significantly improved postintervention with MTM. ConclusionHome-delivered MTM is feasible and acceptable in pregnant patients with diabetes and may improve diabetes self-efficacy. Individual experiences offered insight into various barriers overcome by using this service. Home-delivered MTM may help ensure an accessible, healthy diet for pregnant patients with diabetes.

Are e-Health Interventions Effective in Reducing Diabetes-Related Distress and Depression in Patients with Type 2 Diabetes? A Systematic Review with Meta-Analysis.

Background: e-Health refers to any health care service delivered through the internet or related technologies, to improve quality of life. Despite the increasing use of e-health interventions to manage type 2 diabetes (T2D), there is a lack of evidence about the effectiveness on diabetes distress and depression, which are common issues in those living with T2D. Purpose: To synthesize and determine the effects of e-health interventions on diabetes distress and depression among patients with T2D. Methods: We systematically searched PubMed, Scopus, Cochrane CENTRAL, and Web of Science for randomized controlled trials (RCTs), non-RCTs and observational cohort studies for the effects of e-health interventions on diabetes distress and depression in patients with T2D up to September 14, 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 recommendations were followed. The risk of bias was assessed according to the Risk-of-Bias 2 tool (RCTs), the Risk Of Bias In Non-randomised Studies-of Interventions (ROBINS-I) (non-RCTs) and the National Institute of Health tool (observational). The standardized mean difference (SMD) and its related 95% confidence intervals (CIs) were estimated with the DerSimonian-Laird method through random-effect models. A pooled raw mean difference (MD) meta-analysis was conducted for RCTs comparing the effects of e-health versus control on diabetes distress screening to display the clinical impact. Results: A total of 41 studies (24 RCTs, 14 non-RCTs, and 3 observational) involving 8,667 individuals were included. The pooled SMD for the effect of e-health versus the control group on diabetes distress was -0.14 (95% CI = -0.24 to -0.04; I2 = 23.9%; n = 10 studies), being -0.06 (95% CI = -0.15 to 0.02; I2 = 7.8%; n = 16 studies) for depression. The pooled raw MD on diabetes distress screening showed a reduction of -0.54 points (95% CI = -0.81 to -0.27; I2 = 85.1%; n = 7 studies). Conclusion: e-Health interventions are effective in diminishing diabetes distress among adults with T2D, inducing clinically meaningful reductions.

The importance of asking about wellbeing in a diabetes foot clinic

AbstractThe onset of diabetes foot complications signals a new stage of diabetes progression. Amputation may be the result of such difficulties and can impact upon all aspects of a person's life such as mobility, independence, relationships, and possible loss of earning potential, all likely triggers of distress.The aim of this article is for a health care professional to understand more about the types of distress experienced by individuals with diabetes. It will consider whether routine screening could help diabetes podiatry teams improve the outcomes of their patients.Living with a long‐term condition such as diabetes can be stressful due to increased self‐management responsibilities and the potential for long‐term complications. Diabetes can interact with a person's mental health, including depression or anxiety.The concept of diabetes distress describes the emotional distress resulting from living with diabetes and the burden of relentless daily self‐management. As this type of distress is relatively common, and impacts upon self‐care, it is important that every consultation includes a chance for a person living with diabetes to say how they are feeling.Screening is one way a team can easily identify diabetes distress and provides the opportunity to discuss how each individual is coping with diabetes and life generally.A routine brief screening measure such as the two‐item Diabetes Distress Screening instrument (DDS2) can be quickly and easily administered by health care professionals within a busy diabetes podiatry clinic and helps initiate an all‐important conversation about wellbeing. Copyright © 2023 John Wiley &amp; Sons.

655-P: Diabetes Distress and Associated Factors among Low-Income Chinese Immigrants with Type 2 Diabetes

Purpose: To describe diabetes distress and its associated factors among Chinese immigrants with type 2 diabetes (T2D) in NYC. Methods: Cross-sectional data were derived from three research studies conducted among Chinese immigrants with T2D in NYC. Diabetes Distress Scale (DDS) was used to measure diabetes distress, which includes 4 subscales: emotional, regimen, interpersonal and physician-related distress. A total or subscale score ≥ 2 indicates a moderate or higher distress level and is considered clinically important. Patient Health Questionnaire-2 was used to measure depressive symptoms. Participants’ sociodemographic data were collected. Descriptive statistics and stepwise logistic regression were used. Results: Most participants (n=178) were currently married (76%), limited English proficient (93%), high school graduates or less (66%), and had an annual household income of less than $25K (62%). The mean age was 63.6 (SD=13.6) years old. About 26% of them reported moderate or higher overall distress levels. The most common sources of distress were emotional burden (30%), followed by regimen (29%), interpersonal (19%), and physician-related distress (14%). Participants who were younger, female, and had elevated depressive symptoms were more likely to have higher diabetes distress. Conclusions: Diabetes distress is prevalent in Chinese immigrants with T2D, especially emotional distress and regimen-related distress. Given the known negative impact of diabetes distress, it is critical to consider screening for diabetes distress and incorporating psychological counseling in diabetes care in this underserved population. Disclosure L.Hu: None. Y.Shi: None. C.Wang: None. H.Li: None. H.Bao: None. X.Xu: None. Y.Jiang: None. M.Sevick: None. N.Islam: None. Funding National Institutes of Health (R00MD012811, P30DK111022, U54MD000538-15)

676-P: Diabetes Distress, Medical Education, and Gamification in a Pediatric/Young Adult Diabetes Center

Purpose: It is well known that children, adolescents, and young adults with diabetes face numerous obstacles to adherence. Diabetes distress can lead to diabetes burnout, which worsens diabetes nonadherence. We initiated diabetes distress screening to determine the impact of diabetes distress on our patients and developed games and animated videos in an attempt to assess diabetes knowledge and decrease visit stress. Methods: Diabetes patients aged 10 and older were given the two-question diabetes distress screening scale (DDS2) during their routine follow-up visits. Two games were created to play at the beginning of each appointment and two animated medical education videos were created on how to recognize and manage diabetes distress. Results: A total of 207 patients received DDS2 screening questionnaires. The mean DDS2 score was 5.6 (Type 1, n=178) and 5.5 (Type 2, n=29) out of 12 possible points. Only a weak correlation was found between the DDS2 score and hemoglobin A1C (Type 1:R2=0.34, Type 2:R2=0.18) with essentially no correlation noted between diabetes duration and DDS2 score (Type 1:R2=0.001; Type 2:R2=0.01). Ninety-seven percent of patients liked the “pin the bone on your A1C” game, while 93% enjoyed the medical education quiz game, 80% felt they learned something from it, and 89% felt that it made them more relaxed for their visit. Conclusions: Diabetes distress can lead to diabetes burnout, thus it is important to identify when present. Our data suggest that distress may sometimes be hidden, hence we should specifically screen for diabetes distress in all our pediatric patients that are tweens and older as no significant correlation was found between DDS2 score, hemoglobin A1C, and duration of diabetes. Therapy can be then directed to ameliorating the stress and burnout associated with living with diabetes while the use of easily created educational games and animated videos can be helpful adjuncts to assess patient knowledge while simultaneously lessening appointment stress. Disclosure T.Imai: None. T.Nguyen: None. T.S.Stanic: None. D.Diaz: None. D.Lopez: None. R.Kinman: None.

989-P: Glycaemic Control, Hypoglycaemia Unawareness, and Diabetes-Related Distress in Middle-Old (75 to 85 Years), and Old-Old (&amp;gt;85) before and after Flash Glucose Monitoring in People Living with Diabetes—Association of British Clinical Diabetologist Study

Introduction: There are limited data on the effect of intermittently scanned flash glucose monitoring (isCGM) on glycaemic control, hypoglycaemia unawareness and diabetes-related distress in middle-old (75 to 85 years) and old-old (≥85) people living with diabetes Methods: Clinicians were invited to submit isCGM data to a secure web-based tool held within the National Health services N3 network. We collected baseline data before FSL initiation, such as patient demographics, glycated haemoglobin (HbA1c) values from the previous 12 months, Gold score and Diabetes Distress Screening scale (DDS2) score. We compared the baseline clinical characteristics across the age categories using a t-test. All the analyses were done in R 4.1.2. Results: The study consisted of 16997 people with Type 1 diabetes with baseline and follow-up data, of which 342 were classified as middle-old, and 50 were classified as old-old (94% T1D). The use of isCGM was associated with significant improvement in Gold score in both middle-old (3.54 at baseline vs 3.02 at follow-up, P=0.04) and old-old populations (4.04 at baseline vs 2.72 at follow-up, P=0.01). The use of isCGM was also associated with significant improvement in DDS2 scores in both middle-old (2.53 at baseline vs 2.02 at follow-up, P&amp;lt;0.001) and old-old populations (2.40 at baseline vs 1.73 at follow-up, P&amp;lt;0.01). However, there was no significant effect of isCGM on glycaemic control in middle-old (64.2 mmol/mol at baseline vs 65.2 mmol/mol at follow-up, P=0.45) and old-old populations (60.3 mmol/mol at baseline vs 66.6 mmol/mol at follow-up, P=0.05). Conclusion: The use of isCGM was associated with significant improvement in diabetes-related distress and hypoglycaemia unawareness in middle-old and old-old people living with diabetes but did not affect glycaemic control in this population. Disclosure H.Deshmukh: None. E.G.Wilmot: Advisory Panel; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk, Sanofi, Roche Diabetes Care, Embecta, Consultant; Springer Healthcare, Research Support; Abbott Diabetes, Diabetes UK, Insulet Corporation, Novo Nordisk, NIH - National Institutes of Health, Speaker's Bureau; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk, Sanofi, Ypsomed AG, Glooko, Inc. C.Walton: None. R.E.Ryder: Other Relationship; Novo Nordisk, Speaker's Bureau; GI Dynamics, BioQuest. T.Sathyapalan: Other Relationship; Novo Nordisk, Abbott Diabetes, Research Support; Abbott Diabetes, Novo Nordisk, Eli Lilly and Company.

Diabetes Distress in Uninsured Patients with Diabetes During COVID-19 Pandemic: A Longitudinal Observational Study

ABSTRACT This study assessed diabetes distress (DD) and glycemic control levels through three time periods during the COVID-19 pandemic in uninsured patients with diabetes. Diabetes Distress Screening Scales 2 and 17 were utilized to identify the prevalence of DD among uninsured patients during multiple stages of the COVID-19 pandemic at the Providing Access to Healthcare (PATH) diabetes clinic at the University of Alabama at Birmingham. For the 328 uninsured diabetic patients who were screened for DD at least once, the mean age was 46 years old with a majority being Black (55.5%), male (56.1%), and non-Hispanic (89.9%). Mean scores reflecting patients’ level of DD initially increased in the first 6 months of the pandemic, from 2.86 to 3.44, and then decreased after 12 months of the COVID-19 pandemic to 3.09, while their mean hemoglobin A1c (HbA1c) followed a similar pattern of initial increase (from 11.31 to 12.13) followed by a decline (to 10.79). Addressing patient concerns quickly through early interventions to provide alternative means of care through telehealth and accommodating safe pick-up of diabetes supplies and medications, including insulin, can reduce DD and contribute to better management of glycemic control. Understanding the potential direct correlation of DD with HbA1c in uninsured patients with diabetes is an important factor for clinicians when providing care to this vulnerable population.

The prevalence of diabetes distress and its association with glycaemia in young people living with insulin-requiring-diabetes in a regional centre in Australia.

Emotional responses, such as feeling overwhelmed with diabetes-related treatment, burnt-out and anxiety, are known as 'diabetes distress'. This study aimed to determine diabetes distress among children, adolescents and parents/carers managing insulin-requiring diabetes in a regional Australian setting, and to assess association with glycaemia. All children, adolescents and their parents/carers attending a regional hospital outpatient diabetes clinic between March 2018 and June 2019 were invited to complete a validated child, adolescent or parent/carer diabetes distress questionnaire. Demographics and time-matched clinical data were obtained from hospital records. A cross-sectional analysis was performed. A total of 43 young people and 30 parents/carers completed a diabetes distress questionnaire during the study period. Diabetes distress was common, with 63% of young people and 67% of parents/carers nominating at least one serious concern. After adjustment for potential confounding factors, higher glycaemia (HbA1c %) was associated with higher distress scores among both young people (ß 6.2, 95% confidence interval (CI): 3.2-9.2, P< 0.001) and carers/parents (ß 5.6, 95% CI:1.5-9.8, P< 0.001). Diabetes distress did not differ by child age, duration of diagnosis or mode of insulin administration. For children, adolescents and carers, 'serious concerns' most commonly related to the impact of diabetes upon family and peer relationships. Diabetes distress was common and associated with sub-optimal glycaemia. Routine screening for diabetes distress should be considered in paediatric services. Development of strategies to minimise diabetes distress for youth and families is required.

Time in range following flash glucose monitoring: Relationship with glycaemic control, diabetes-related distress and resource utilisation in the Association of British Clinical Diabetologists national audit.

The aim of this study was to understand the relationship between time in range (TIR) achieved using the isCGM with changes in glycaemic control, diabetes-related distress (DRD) and resource utilisation in people living with diabetes. Clinicians from 106 National Health System (NHS) UK hospitals submitted isCGM user baseline and follow-up data in a web-based tool held within the UK NHS network. Linear regression analysis was used to identify the relationship between follow-up glucose TIR (3.9-10 mmol/L) categories (TIR% 50-70 and TIR% >70) with change in haemoglobin A1c (HbA1c), DRD and Gold score (measure of hypoglycaemia unawareness, where a score ≥4 suggests impaired awareness of hypoglycaemia). Of 16,427 participants, 1241 had TIR follow-up data available. In this cohort, the mean TIR was 44.8% (±22.5). With the use of isCGM, at 7.9months mean follow-up, improvements were observed in HbA1c (-6.9 [13.5]mmol/mol, p < 0.001), Gold score (-0.35 [1.5], p < 0.001) and Diabetes Distress Screening (-0.73 [1.23], p < 0.001). In the regression analysis restricted to people living with type 1 diabetes, TIR% 50-70 was associated with a -8.9 mmol/mol (±0.6, p < 0.001) reduction in HbA1c; TIR% >70 with a -14 mmol/mol (±0.8, p < 0.001) reduction in HbA1c. Incremental improvement in TIR% was also associated with significant improvements in Gold score and DRD. TIR% >70 was associated with no hospital admissions due to hypoglycaemia, hyperglycaemia/diabetic ketoacidosis, and a 60% reduction in the paramedic callouts and 77% reduction in the incidence of severe hypoglycaemia. In a large cohort of UK isCGM users, we demonstrate a significant association of higher TIR% with improvement in HbA1c, hypoglycaemia awareness, DRD and resource utilisation.

Exploring the Needs of Adults Living With Type 1 or Type 2 Diabetes Distress Using the Problem Areas in Diabetes 5 Tool

ObjectivesThis study investigated the feasibility and acceptability of implementing a screening tool as a part of routine care and the subsequent screening experiences of patients and clinicians. Additionally, potential sources of diabetes distress (DD) were identified in this clinical population. MethodsOur investigation was a cross-sectional, mixed-methods, convenience sample of 203 patients living with type 1 or type 2 diabetes from 2 Canadian tertiary hospital–based clinics. The Problem Areas in Diabetes 5 (PAID5) scale was used to assess DD. Structured telephone interviews of patients with high DD scores and care provider focus group transcriptions were analyzed using a deductive thematic content analysis. ResultsThe prevalence of DD was 45%. Lack of medication coverage (p=0.02) and presence of neuropathy (p=0.04) were approximately 5- and 2-fold more likely to be predictors of high DD, respectively. Patient interviews identified DD screening as an opportunity to share and feel supported but demonstrated their fear of discussing mental health concerns. Patients found discussion about mental health helpful and often did not require a referral to a mental health specialist. Staff focus groups discussed screening as a feasible tool, but also acknowledged barriers and knowledge gaps that preclude DD screening integration in routine clinical practice. Specialized training for clinicians may help increase confidence and improve uptake of DD screening into routine clinical practice. ConclusionsThe prevalence of DD in outpatient care settings is high. Findings suggest that integrating the PAID5 screening tool into regular clinical practice is feasible by patients and care providers.

Diabetes-related distress and its association with the complications of diabetes in Iran.

PurposeDiabetes-related distress (DRD) has negative emotional effects on the patients’ quality of life. This is while the condition often goes undiagnosed despite it being common among diabetic patients. This study investigated the prevalence of DRD and its association with diabetes complications among a group of Iranian type 2 diabetic patients (T2DM).MethodsThis descriptive-analytical cross-sectional study was conducted on 186 T2DM patients referred to a diabetes clinic in a teaching hospital from the beginning of May 2019 to the end of April 2020. Two questionnaires on disease-related information and diabetes distress screening scale (DDS) were filled out for each patient. The latter was divided into four domains, emotional burden (EB), diabetes-related interpersonal distress (ID), physician-related distress (PD), and regimen-related distress (RD). In addition to the frequency of DRD and its association with age, sex, body mass index (BMI), hypertension, hemoglobin A1C, duration of disease, and type of medication regimen (oral, insulin, or mix) along with the history of cardiovascular disease (CVDs), retinopathy, nephropathy, and diabetic foot were assessed.ResultsDRD was reported in 47% of the patients. Being female, old age, hypertension, high hemoglobin A1C levels, nephropathy, and retinopathy were significantly associated with DRD (P-value = < 0.001, 0.013, 0.014, 0.007, 0.001, and 0.004, respectively). The history of the diabetic foot had a significant relationship with PD and ID (P-value = 0.007 and < 0.001, respectively). Multivariate regression showed gender and the existence of complications to have a direct effect on the development of DRD.ConclusionDRD prevalence is relatively high and requires screening to identify and treat high-risk patients. Further studies are needed to study diabetes, its complications and their relation with DRD to help reduce such conditions and improve the patient’s quality of life.

Prevalence of Diabetes Distress Among Adolescents With Type 1 Diabetes Mellitus

Adolescents with type 1 diabetes mellitus (T1DM) are at increased risk for diabetes distress. This cross-sectional study used the Diabetes Distress Scale (DDS) to determine diabetes distress among adolescents with T1DM in a pediatric endocrinology clinic. Sixty-one percent of respondents reported moderate to significant diabetes distress levels, with overall diabetes distress of M = 2.409 (SD = 0.853). Emotional burden subcategory had the highest distress (M = 3.214, SD = 1.449). Minimal distress levels were reported in the physician burden subcategory (M = 1.133, SD = 0.276). Results support the need for routine diabetes distress screening.

Distress and Living with Diabetes: Defining Characteristics Through an Online Survey.

IntroductionThere is considerable evidence for diabetes reducing quality of life. The impact of such a diagnosis on mental health is less well understood and was subsequently explored here.MethodsOnline PHQ-9 scores (which calculate the severity of depression), Diabetes Distress Screening Scale (DDSS) and EQ-5D-5L (quality-of-life) questionnaires were completed by patients with diabetes, followed by the extraction of data where possible from responders’ clinical records.ResultsA total of 133 people submitted questionnaires. However, not all data items could be completed by each patient; 35% (45/130) had type I diabetes mellitus (T1DM); 55% (64/117) were women. The overall median age of 117 responders was 60 (IQR 50–68 years). The median aggregated response scores were: EQ-5D-5L 0.74 (IQR 0.64–0.85) (lower quality of life than UK population median of 0.83), DDSS 1.9 (IQR1.3–2.7) (≥ 2 indicates moderate distress) and PHQ-9 5 (IQR2-11) (≥ 5 indicates depression). Higher diabetes distress (DDSS)/lower quality of life EQ-5D-5L/higher depressive symptoms (PHQ-9) linked to female sex (DDSS 0.5/25% above median), younger age (< 50 years DDSS 0.7/35% above median), fewer years after diagnosis (< 10 years DDSS 0.8/40% above median), and obesity (BMI > 35 DDSS 0.6/30% above median). Additionally, a HbA1c reading of ≤ 48 mmol/mol was associated with higher DDSS scores, as did a reduction of more than 5 mmol/mol in HbA1c over the last three HbA1c measurements. The 30 individuals with a history of prescribed antidepressant medication also showed higher diabetes distress scores (DDSS 0.9, equating to 45% above the median). The DDSS score elevation came from an increase in emotional burden and regimen-related distress. DDSS scores were not significantly linked to diabetes type, insulin use, absolute level/change in blood glucose HbA1c. Physician-related distress showed a similar pattern.ConclusionsA low level of stress in relation to diabetes management may be associated with lower HbA1c. The larger impact of diabetes on mental health in younger women/people with shorter diabetes duration should be noted when considering psychosocial intervention/behavior change messaging. Physician-related distress is a potentially remediable factor. However, this sample was self-selecting, limiting generalization to other samples.