Association of diabetes-related distress, depression, medication adherence, and health-related quality of life with glycated hemoglobin, blood pressure, and lipids in adult patients with type 2 diabetes: a cross-sectional study

Abstract

This study examined the associations of diabetes-related distress (DRD), depressive symptoms, health-related quality of life (HRQoL), and medication adherence with glycemia, blood pressure (BP), and lipid biomarkers in adults with type 2 diabetes mellitus (T2D). This cross-sectional study was conducted in three Malaysian public health clinics in 2012–2013, recruited adult patients (aged ≥30 years) with T2D who had been diagnosed for more than one year, were on active follow-up, and had recent blood test results. Univariable and multivariable analyses were performed to identify significant associated factors for glycated hemoglobin (HbA1c) BP, and lipids. The response rate was 93.1% (700/752). The majority were females (52.8%), Malay (52.4%), and married (78.7%). DRD correlated with systolic BP (r= −0.16); depressive symptoms correlated with low-density lipoprotein cholesterol (r=0.12) and total cholesterol (r=0.13); medication adherence correlated with HbA1c (r= −0.14) and low-density lipoprotein cholesterol (r= −0.11); and HRQoL correlated with casual blood glucose (r= −0.11), high-density lipoprotein cholesterol (r= −0.13), and total cholesterol (r= −0.08). Multivariable analyses showed that HRQoL was significantly associated with casual blood glucose (adjusted B= −0.06, P=0.024); DRD was associated with systolic BP (adjusted B= −0.08, P=0.066); depressive symptoms were associated with low-density lipoprotein cholesterol (adjusted B=0.02, P=0.061), and medication adherence was associated with HbA1c (adjusted B= −0.11, P=0.082) and total cholesterol (adjusted B= −0.06, P=0.086). There were significant and distinctive associations of DRD, depressive symptoms, HRQoL, and medication adherence with glycemia, BP, and lipid biomarkers. Unexpected beneficial therapeutic effects of DRD on BP require further study. A multidisciplinary approach may be needed for risk management in adults with T2D at the primary care level.

‘Diabetes is a gift from god’ a qualitative study coping with diabetes distress by Indonesian outpatients

“…In the United States of America and South Africa studies, they found similar DD-related factors, such as younger age and lower levels of public healthcare support [10,11]. Two studies in Malaysia revealed that being female, having higher levels of systolic blood pressure [12], having a level of HbA1c more than 8.5%, the presence of comorbid, lifestyle and family history of psychiatric illness were all highly associated with a high level of DD [13]. Furthermore, an Iran study reported that being female and the level of education to be the significant predictors of DD [14].…”

The associations between diabetes distress and self-efficacy, medication adherence, self-care activities and disease control depend on the way diabetes distress is measured: Comparing the DDS-17, DDS-2 and the PAID-5

“…Both instruments were also associated with quality of life [13][14][15], but with medication adherence only an association was found with PAID-20 [13; 16]. In terms of disease control, PAID-20 was associated with poor glycemic control (HbA1c > 8%) [14; 17], while higher DDS-17 scores were associated with lower systolic blood pressure (adjusted B= -0.08, P=0.066), and no association was observed with lipid profiles with DDS-17 but yet to be investigated with PAID [17]. To summarize, it is currently unclear whether the choice for a certain measure of DD will lead to different conclusions when used in the same population with regard to its association with patientreported and clinical outcomes.…”

Assessment of Health-Related Quality of Life using the EQ-5D-3L in Individuals with Type 2 Diabetes Mellitus

“…It has a negative impact on individuals, affecting all spheres of life and reducing their quality of life [7,8]. The psychosocial [9] and psychological [10,11] problems associated with diabetes, as well as the burden of disease and the lifestyle restrictions of diabetic patients are widely addressed in the literature [12]. For these reasons, individuals with DM need ongoing professional support and specific training to minimize complications and improve their well-being [13][14][15].…”