Associations of depression and diabetes distress with self-management behavior and glycemic control.

Abstract

Objective: To analyze the independent associations of depression and diabetes distress with self-management and glycemic outcome in Type I (T1DM) and Type 2 diabetes (T2DM). Method: Six hundred six people with T1DM or T2DM participated in a cross-sectional survey including measures of depression (PHQ-9), diabetes distress (PAID-5), self-management behavior (DSMQ), and glycemic outcome (HbA1c). Structural equation modeling was performed to analyze the independent linear associations (standardized coefficients) between these variables. Results: In those with T1DM (n = 339), both depressive symptoms and diabetes distress were associated with lower self-management (−0.34, p < .001, and −0.16, p = .007, respectively) and thereover (indirectly) with higher HbA1c (0.20, p < .001, and 0.10, p = .016, respectively); direct associations with HbA1c were not observed. In those with T2DM (n = 267), only depressive symptoms were associated with lower self-management (−0.41, p < .001) and thus (indirectly) with higher HbA1c (0.17, p < .001). Diabetes distress, by contrast, was directly associated with higher HbA1c (0.20, p = .003) but not with self-management. Conclusions: The results are consistent with the hypothesis that depression is linked to less optimal diabetes self-management, thus leading to less optimal glycemic outcome. The associations were relatively consistent across diabetes types. Diabetes distress was additionally associated with higher glycemic levels, suggesting that people with both depression and diabetes distress might have the least optimal outcome. The conclusions are limited by the cross-sectional study design, self-report assessment of behavior, and potential bias arising from questionnaire measures. Further research is needed to support these findings.

The Impact of Self-Stigma, Role Strain, and Diabetes Distress on Quality of Life and Glycemic Control in Women With Diabetes: A 6-Month Prospective Study

“…Higher baseline role strain and diabetes distress were significantly correlated with higher baseline A1C levels and higher 6-month A1C levels in bivariate analysis, which is consistent with previous studies (Huang et al, 2020; Schmitt et al, 2021). Nevertheless, this prospective study supported that higher self-stigma, role strain and diabetes distress did not directly associate but indirectly associated with higher baseline A1C levels and 6-month A1C levels through the mediation of D-QoL.…”

Assessment of diabetes-related distress among type 2 diabetic patients, Riyadh, Saudi Arabia

“…Studies have shown the association between depression and diabetes complications and mortality. [ 22 23 ] Over 80% of T2DM patients with moderate or high DRD are not clinically depressed and that, among those who are clinically depressed, many of the depressive symptoms reported are related to diabetes. [ 24 ] DRD was found to be significantly associated with HbA1c, and increased HbA1c was related to emotional functioning.…”

Psychodynamics in Diabetes: The Relevance of Deepening the Symbolic in Treatment Adherence

“…Minimizing the severity of perceived threats may reduce diabetes distress and contribute to proper glycemic control (Tripathy et al, 2012 ; Marchini et al, 2020 ; Martino et al, 2020a ) (e.g., the patient may claim that he/she is unconcerned about having diabetes as it is not a serious disease). In this regard, compared to healthy controls, patients with diabetes resort to reversal to a greater extent, which appears to help them lessen depressive feelings (Marchini et al, 2020 ) but prevents effective diabetes management (Graham et al, 2020 ; Schmitt et al, 2021 ).…”

“…In this regard, depressive and anxiety symptoms are often reported by patients with diabetes because of the disease-related distress including worry about complications, fear of hypoglycemia, and guilt feelings about uncontrolled blood glucose (Nouwen, 2015 ; Sartorius, 2018 ; Shinkov et al, 2018 ; Wardian et al, 2018 ). Overall, this difficulty complying with the stressful rigors of diabetes and required lifestyle changes tends to worsen glycemic control, resulting in higher hemoglobin A 1c levels and less optimal outcomes (Whithorth et al, 2016 ; Egan et al, 2017 ; Fukuda and Mizobe, 2017 ; Graham et al, 2020 ; Schmitt et al, 2021 ). Therefore, to promote higher patient self-care and treatment adherence, a primary task for healthcare professionals is reducing diabetes distress by improving patients' skills at regulating negative emotions (Coccaro et al, 2021 ).…”