Prevalence of diabetes-related distress in patients with type 2 diabetes, attending a tertiary care hospital

P. Gowri

Consultant Diabetologist, Kauvery Speciality Hospital, Cantonment, Trichy, India

*Correspondence: dr.gowriaravindakumar@kauveryhospital.com

Abstract

According to the International Diabetes Federation, there are 382 million people worldwide affected by diabetes and India has 65.1 million people with diabetes. The majority of the guidelines on diabetes care focus on the medical aspects of disease management without addressing the psychological needs of the patient. These psychosocial problems can eventually develop into depressive or other psychological disorders.

Although many people with diabetes cope well and live healthy lives, several studies, including The Diabetes Attitudes, Wishes, and Needs (DAWN) study [1], emphasized that psychological support in this group of patients is under-resourced and inadequate. Results from the DAWN study indicate that psychological problems are common among diabetic patients and addressing the psychological needs improves HbA1c by 0.5–1% in adults with T2DM.

Background

Mental Health and Diabetes are two-way traffic. Any mental illness can affect the risks and outcomes of diabetes. Psychiatric disorders that are prevalent in people with diabetes are diabetes distress, depression, anxiety, eating disorders, phobia, dementia, etc.

Diabetes distress (DD) is a hidden negative emotional condition that results from living with diabetes and the burden of relentless daily self-management. In one of the largest cohort studies to date, severe diabetes distress was reported in one in four people with type 1 diabetes, one in five people with insulin-treated type 2 diabetes, and one in ten people with non-insulin-treated type 2 diabetes (MILES-2 Study) [2].

In recent years more and more, younger people are affected with diabetes, which in turn increases the global burden of diabetic distress, imposing mental health issues on patients and the health care system. Unfortunately, there is little information related to diabetes distress in South Indian population. Hence this study was conducted to estimate the prevalence of diabetes distress and determine its demographic predictors among adults with T2 DM. In this study, we assessed the prevalence of diabetes distress in adult Type 2 diabetic patients attending the diabetic OPD in a tertiary care hospital and identified the impact of demographic features on the severity of diabetes distress.

Methods

This is a cross-sectional, observation study conducted at the diabetic OPD, Kauvery Specialty hospital, Trichy. The study was done over a period of two weeks. Of 122 participants were selected using convenience sampling of adults with T2 DM who could read and understand English. Diabetes distress scale 17 was used.

The DDS-17 assesses diabetes-related difficulties and problems during the preceding month on a Likert scale ranging from 1 (no problem) to 6 (serious problem). The DDS provides a total DD score and four subscale scores, addressing emotional burden (five Items), physician-related distress (four items), regimen-related distress (five items,), and diabetes-related interpersonal distress (three items). Each subscale was scored separately by dividing the sum of its item scores by the number of items. Additionally, the mean total distress score was calculated by calculating the sum of the 17 items and dividing by 17. A mean item score of <2.0 indicates little or no distress, 2.0–2.9 indicates moderate distress, and >3.0 indicates high distress. DD was considered a dichotomous variable in this study, with patients considered to have DD if DDS-17 scores were >2. Participants were explained about the questionnaire in detail and made to understand the implications.

Statistical analysis was performed using SPSS, (Version 23.0). The continuous variable will be expressed as mean and standard deviation. Categorical variables will be expressed as frequency and percentage. Independent ‘t’-test will be used to find the significant difference between groups. Correlation relationship between two variables analysed by applying Pearson’s coefficient. The Chi-square test and fisher’s exact test are used to find out the association between the categorical variables. p < 0.05 will be considered statistically significant.

Results

Data from 122 adults with T2DM were analysed. Among them, 44.2% were males 55.8% were females. The mean age of the participants was 55.8 ± 11.4 years. Half of the study population was in the age group 41–60 years (51%). The remaining 12% of the participants were in the age group 20–40 years and 37% were above 60 years of age. The 32.8% of patients had less than 5 years of diabetes duration, 36.1% had 6–10 years and 31.1% had more than 10 years duration of diabetes. The mean duration of diabetes was 9.4±6.5 years.

Table 1: Age Range Vs Complications


Age range



Complications



Total



%



p-value

Yes



%



No



%

20–40



2



13.3



13



86.7



15



12



χ2= 0.000 SIG

41–60



42



67.7



20



32.3



62



51

Above 60



37



82.2



8



17.8



45



37

Over All



81



66.4



41



33.6



122



 

Two-thirds of the study population (66.4%) had one or more complications. 88.2% of the adults are above 60 years of age had one or more complications. The prevalence of diabetic complications increased as the age of the patients increased which was statistically significant (p-value = 0.000).

Diabetes distress was seen in 16% of the study population. Male patients had a higher prevalence of diabetes distress (17%) when compared to female patients (15%). Among the male patients, diabetes distress was more prevalent in the 41–60 years age group.

Diabetes-distress-scaleFig. 1. Diabetes distress scale.

The four subscale scores of DDS were Emotional burden (moderate 15%, severe 4%), physician-related distress score (moderate 6%, severe 3%), regimen-related distress score (moderate 11%, severe 7%), and diabetes-related interpersonal distress score (moderate 9%, severe 5%) (Fig. 1).

Discussion

The mean level of diabetes distress in our study (16%) as measured by DDS was lower when compared to other studies (42%) in our country [3]. One reason may be that they are healthy diabetic patients regularly attending our diabetic OPD, where comprehensive diabetic care is given. Regular diabetic education on self-care, diet restriction, physical activity, and foot care is provided periodically by a dedicated diabetic care team. Another reason may be that they are reluctant to share their distress with us. Emotional burden-related distress was highly prevalent among the four domains of the diabetic distress scale which is in concordance with other studies.

Conclusion

Monitoring diabetes distress as part of routine clinical care is essential to identify the hidden psychological barriers to diabetes management. Healthcare providers need to integrate psychosocial care with collaborative medical care.

Acknowledgement

I wish to acknowledge the help provided by my OP staff in data collection. Assistance provided by Mr. Dhasaratharaman, Statistician is greatly appreciated.

References

  1. Peyrot M, Rubin RR, et al. Psychosocial problems and barriers to improved diabetes management: results of the cross-national Diabetes Attitudes, Wishes, and Needs study. Diabet Med. 2005;22:1379-85.
  2. Ventura AD, Browne JL, et al. Diabetes MILES-2 2016 Survey Report. Melbourne, AU: Diabetes Victoria; 2016.
  3. Patra S, Patro BK, et al. Prevalence of diabetes distress and its relationship with self-management in patients with type 2 diabetes mellitus. Ind Psychiatry J. 2021;30(2):234-9.

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