Diabetes Distress: The Untold Hidden Struggle of Living with Diabetes Mellitus

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Abstract

In recent years, the global burden of diabetes distress has increased significantly, imposing mental health issues on patients and the healthcare system. Diabetes-related distress differs from depression as it originates from the mental and emotional burden that comes from the ongoing management of diabetes. Studies have revealed that one in four individuals with type 1 diabetes has increased levels of diabetes distress, and one in five people with type 2 diabetes experiences increased levels of diabetes distress. Patients with diabetes experience psychosocial and emotional problems in response to these lengthy therapies, including worry about complications, fear of hypoglycemia, fatigue regarding poorly controlled blood glucose, worthlessness, the need for support, and access to healthcare. Psychological factors such as diabetes-related emotional distress have been linked with lower compliance to diet, exercise, frequent blood glucose testing, and medication regimens. Patients with a higher level of diabetes-specific emotional distress have been shown to have a lower health-related quality of life. Despite the increased awareness and knowledge of diabetes-related distress, patients with diabetes are not routinely screened during clinic visits. Therefore, nurses must continually observe and assess a patient's physical and emotional response to treatment and identify patterns and trends suggestive of diabetes-related distress.

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Most cited references 36

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Pouya Saeedi, Inga Petersohn, Paraskevi Salpea … (2019)

To provide global estimates of diabetes prevalence for 2019 and projections for 2030 and 2045.

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Assessing psychosocial distress in diabetes: development of the diabetes distress scale.

William H. Polonsky, Lawrence Fisher, Jay Earles … (2005)

The purpose of this study was to describe the development of the Diabetes Distress Scale (DDS), a new instrument for the assessment of diabetes-related emotional distress, based on four independent patient samples. In consultation with patients and professionals from multiple disciplines, a preliminary scale of 28 items was developed, based a priori on four distress-related domains: emotional burden subscale, physician-related distress subscale, regimen-related distress subscale, and diabetes-related interpersonal distress. The new instrument was included in a larger battery of questionnaires used in diabetes studies at four diverse sites: waiting room at a primary care clinic (n = 200), waiting room at a diabetes specialty clinic (n = 179), a diabetes management study program (n = 167), and an ongoing diabetes management program (n = 158). Exploratory factor analyses revealed four factors consistent across sites (involving 17 of the 28 items) that matched the critical content domains identified earlier. The correlation between the 28-item and 17-item scales was very high (r = 0.99). The mean correlation between the 17-item total score (DDS) and the four subscales was high (r = 0.82), but the pattern of interscale correlations suggested that the subscales, although not totally independent, tapped into relatively different areas of diabetes-related distress. Internal reliability of the DDS and the four subscales was adequate (alpha > 0.87), and validity coefficients yielded significant linkages with the Center for Epidemiological Studies Depression Scale, meal planning, exercise, and total cholesterol. Insulin users evidenced the highest mean DDS total scores, whereas diet-controlled subjects displayed the lowest scores (P < 0.001). The DDS has a consistent, generalizable factor structure and good internal reliability and validity across four different clinical sites. The new instrument may serve as a valuable measure of diabetes-related emotional distress for use in research and clinical practice.

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To describe a new measure of psychosocial adjustment specific to diabetes, the Problem Areas in Diabetes Survey (PAID), and to present initial information on its reliability and validity.