Diabetes distress and associated factors among adults with diabetes mellitus residing in a metropolitan city of India: a community-based study.

backgroundDiabetes distress "refers to the negative emotional or affective experiences resulting from the challenge of living with the demands of diabetes." Despite recommendations to screen for distress at regular intervals, it usually remains undiagnosed. This study aimed to determine the prevalence of diabetes distress among adults living with diabetes, determine the factors associated with distress, the association between selfcare and distress, glycemic control and distress and compare the health-related quality of life among those with and without distress.

methodsThis cross-sectional, community-based study was conducted in an urban colony in Delhi, India. The participants were selected using simple random sampling and included adults diagnosed with diabetes mellitus. The sample size calculated was 390. The questionnaire included the Diabetes Distress Scale 17, Diabetes Self-Management Questionnaire and Healthy Days measure. Factors associated with distress were tested using bivariate followed by multivariable logistic regression. Multivariable logistic regression was used to find the association between selfcare and distress and glycemic control and distress. Mean number of unhealthy days and health rating were compared between distressed and non-distressed diabetics using Wilcoxon rank sum test and chi square test respectively.

resultsA total of 412 adults were included in the study, of which 35.4% had clinically significant distress. Female sex, low socio-economic status, 1 or more comorbidities, diagnosis of diabetes 10 or more years prior, being on treatment and an unmet need for social support were the factors found to be associated with distress. There was a positive association between physicians contact and distress. Those with poor glycemic control had higher odds of distress. There was a significant difference in the health reported by those with and without distress (p < 0.001). Those with distress also suffered from significantly more physically unhealthy days and mentally unhealthy days than those without distress (p < 0.001).

conclusionIn this study, more than one in three diabetics were found to be distressed. Healthcare providers should increase their focus on the psychological aspects of diabetes and improve their communication with patients. Diabetes distress needs to be screened for in routine clinical settings and addressed appropriately.