Association between diabetes distress and all-cause mortality in Japanese individuals with type 2 diabetes: a prospective cohort study (Diabetes Distress and Care Registry in Tenri [DDCRT 18])

Abstract

Aims/hypothesis The absence of data on the direct association between diabetes-specific distress and all-cause mortality in individuals with diabetes prompted us to examine the temporal association between Problem Areas in Diabetes (PAID) survey scores and the subsequent risk of all-cause mortality in a cohort of individuals with type 2 diabetes. Methods Longitudinal data from 3305 individuals with diabetes were obtained from a large Japanese diabetes registry. Independent correlations between quintiles of PAID total scores or PAID scores of ≥40 and all-cause mortality (median follow-up of 6.1 years) were examined using Cox proportional hazards models with adjustment for potential confounders.Results The study population included 1280 women and 2025 men with a mean age of 64.9 years, BMI of 24.6 kg/m 2 and HbA 1c level of 58.7 mmol/mol (7.5%). In the multivariable-adjusted model, compared with the first quintile of PAID scores, the multivariable-adjusted HRs (95% CIs) for all-cause mortality for the second to fifth quintiles were 1.11 (0.77, 1.60; p = 0.56), 0.87 (0.56, 1.35; p = 0.524), 0.95 (0.63, 1.46; p = 0.802) and 1.60 (1.09, 2.36; p = 0.016), respectively. Compared with a PAID score of <40, the multivariable-adjusted HR for all-cause mortality of those with a score of ≥10 was 1.56 (95% CI 1.17, 2.08; p = 0.002). In subgroup analyses, the association between PAID score and all-cause mortality was found in men (HR 1.76; 95% CI 1.26, 2.46) but not in women (HR 1.09; 95% CI 0.60, 2.00), with a significant interaction between diabetes distress and sex (p = 0.0336). Conclusions/interpretation We observed a significant positive association between high diabetes distress and all-cause mortality in men with diabetes.

More work is needed to better understand diabetes distress as a predictor of all-cause mortality in type 2 diabetes

“…To the Editor: With interest, we read a recently published article in Diabetologia, by Hayashino et al, which focused on the association between diabetes distress and all-cause mortality in a prospective cohort study among 3305 Japanese individuals with type 2 diabetes [1]. Diabetes distress and all-cause mortality were measured once a year during the median follow-up period of 6.1 years.…”

“…The authors conducted several subgroup analyses, investigating whether the association between baseline diabetes distress and all-cause mortality was different for men vs women, participants with different HbA 1c levels, different age groups or different diabetes therapy. The association between high baseline diabetes distress (measured using the Problem Areas in Diabetes [PAID] questionnaire) and higher allcause mortality was found in men (HR 1.76 [95% CI 1.26, 2.46]) but not in women (HR 1.09 [95% CI 0.60, 2.00]), with a significant interaction between diabetes distress and sex (p = 0.0336) [1].…”

“…This raises the question: why did a high level of diabetes distress predict mortality in the male participants but not in the female participants with diabetes? The final Cox proportional hazards models in the whole sample were adjusted for several potential confounders (age, sex, BMI, HbA 1c , types of diabetes therapy, urinary albumin/ creatinine ratio, history of any diabetes retinopathy, symptomatic diabetic neuropathy and past medical history [acute myocardial infarction, chronic stable angina, peripheral artery disease, leg ulceration, ischaemic stroke and haemorrhagic stroke]) [1]. Yet, in order to understand why the association was different for men and women, it would be relevant to provide data on socio-demographic and clinical characteristics for both sexes.…”

“…Yet, in order to understand why the association was different for men and women, it would be relevant to provide data on socio-demographic and clinical characteristics for both sexes. In addition, information regarding the mortality rates for men and women (separately) is not reported [1], while this is needed to interpret the results.…”

“…Furthermore, Hayashino et al measured diabetes distress using the total 20-item scale of PAID. They used a Japanese translation of PAID, reporting that this has shown good consistency and validity [1]. However, earlier research has shown that the sources of diabetes distress can be regarded as a multidimensional construct.…”