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

Unaiza Waheed; Adrian H Heald; Mike Stedman; Emma Solomon; Rustam Rea; Saydah Eltom; J Martin Gibson; Katherine Grady; Arie Nouwen; Gerry Rayman; Angela Paisley

doi:10.1007/s13300-022-01291-3

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

Diabetes Ther. 2022 Sep;13(9):1585-1597. doi: 10.1007/s13300-022-01291-3. Epub 2022 Jul 13.

Authors

Unaiza Waheed¹, Adrian H Heald^{2

3}, Mike Stedman⁴, Emma Solomon⁵, Rustam Rea⁶, Saydah Eltom⁷, J Martin Gibson^{1

8}, Katherine Grady⁹, Arie Nouwen¹⁰, Gerry Rayman¹¹, Angela Paisley^{1

8}

Affiliations

¹ Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK.
² Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK. adrian.heald@manchester.ac.uk.
³ The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK. adrian.heald@manchester.ac.uk.
⁴ Res Consortium, Andover, Hampshire, UK.
⁵ Department of Clinical Psychology, Salford Royal Hospital, Salford, UK.
⁶ Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK.
⁷ Pharmacy Department, Salford Royal Hospital, Salford, UK.
⁸ The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
⁹ Research for the Future, Northern Care Alliance NHS Group, Salford, UK.
¹⁰ Department of Psychology, Middlesex University, London, UK.
¹¹ The Ipswich Diabetes Centre and Research Unit, Ipswich Hospital NHS Trust, Colchester, Essex, UK.

Abstract

Introduction: There 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.

Methods: Online 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.

Results: A 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.

Conclusions: A 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.

Keywords: Depression; Diabetes; Diabetes distress.