Prevalence and determinants of diabetes distress and its association with self-management among patients living with type 2 diabetes: a cross-sectional study from a tertiary care hospital in Sri Lanka.

BACKGROUND

Diabetes distress (DD) refers to the emotional and psychological strain related to the management of diabetes and its complications. It can result in poor self-management behaviours and suboptimal health outcomes. This study aimed to evaluate the prevalence, determinants and impact of DD on self-management behaviours and glycaemic control among people with type 2 diabetes mellitus (T2DM) attending a tertiary care hospital in Sri Lanka.

METHODS

A descriptive, cross-sectional study was conducted at the Diabetes and Endocrine Clinic of the National Hospital, Sri Lanka. DD was measured using the 17-item Diabetes Distress Scale (DDS-17), comprising four domains: emotional burden, physician-related, regimen-related, and interpersonal distress. Self-management was assessed using the Diabetes Self-Management Questionnaire-Revised (DSMQ-R), covering five domains: glucose monitoring, medication adherence, dietary control, physical activity and healthcare use. Both instruments were interviewer-administered. DD severity was defined as clinically significant if DDS-17 score was ≥ 2 (moderate-high level of DD). Logistic regression was used to identify determinants of DD and Spearman’s rank correlation was used to assess the associations between DD, DSMQ-R scores and glycaemic control. A p value of < 0.05 was considered statistically significant.

RESULTS

Among 322 participants (mean age 59.9 ± 10.2 years; mean diabetes duration 11.4 ± 7.7 years), the prevalence of DD was 30.4% (95% CI: 25.7%–35.7%). After adjusting for confounders, determinants of DD were age range of 41–59 years (OR 3.6, 95% CI: 2.0-6.5, p < 0.001), female gender (OR 2.8, 95% CI: 1.4–5.4, p = 0.01), suboptimal glycaemic control of HbA1c ≥ 7% (OR 4.4, 95% CI: 1.9–10.1, p < 0.001) and the presence of comorbidities (OR 3.1, 95% CI: 1.3–7.3, p = 0.01). Self-management activity scores including glucose monitoring, medication adherence, dietary control, physical activity and healthcare use had significant and negative correlations with both DD and HbA1C (p < 0.05).

CONCLUSIONS

Diabetes distress significantly impairs self-management and glycaemic control among people living with T2DM. Routine screening for diabetes-related distress using tools such as the DDS-17 should be integrated into diabetes care to identify patients experiencing moderate-to-high levels of distress and who are therefore at risk of poor self-management and adverse disease outcomes. CLINICAL TRIAL NUMBER: Not applicable.