Vancouver, B.C. – Screening for “diabetes distress” should probably be a part of routine care for patients with type 2 diabetes mellitus, according to investigators from the University of British Columbia, Vancouver.
Dr. Evelyn Wong
The team administered the Diabetes Distress Scale (DDS) questionnaire to 148 consecutive patients with type 2 diabetes at a university diabetes clinic; 39% scored positively for diabetes distress, as indicated by a score of 2 or more on the DDS, and stress correlated with poorer glycemic control. In particular, higher hemoglobin A1c scores correlated, although weakly, with a higher perception of emotional burden from diabetes (r2 = 0.198) and greater stress over treatment regimens (r2 = 0.249). The correlation between stress and worse glycemic control was strongest in patients with hemoglobin A1c above 9% (r2 = 0.387).
After its first appearance in the medical literature over a decade ago, diabetes distress has been shown to impact how well patients do. It’s a mix of negative emotions – for instance, frustration, anxiety, and burnout – related to the management of disease, and it’s been diagnosed in up to 43% of patients in previous studies. Diabetes distress is distinct from clinical depression. In fact, just 12% of the study subjects screened positive for depression on the Personal Health Questionnaire-9, which was administered along with the DDS,. Depression, although related to the use of insulin, had no impact on glycemic control.
“Diabetes distress, particularly emotional and self-care-related distress, is quite high in this population; I think it’s clinically important that we address it. We should be using some sort of screening for distress,” said investigator Dr. Evelyn Wong, an endocrinology fellow at the university.
Previous investigations have found that if distress is reduced, glycemic control improves. How exactly to do that is the subject of ongoing investigation, but education on self-management seems to help. Improving relationships with health care providers and helping patients find alternatives for problematic regimens might also help, Dr. Wong said at the World Diabetes Congress.
“Diabetes is a bit of a silent disease,” at least until complications emerge, “so patients may not understand why they need to take insulin, or why it’s important to bring down hemoglobin A1c. We” have to make sure they understand such issues and help them come to terms with their illness. Overall, “I think it’s the time spent with the patient that is important,” she said.
A unique finding of the Vancouver study was that patients who felt less satisfied with their providers had better glycemic control. Perhaps they had stricter physicians or were more vigilant about their diabetes because they didn’t have much faith in their physician.
The DDS is a 17 item scale that uses 6-point Likert scales to measure the emotional burden of diabetes; its impact on personal relationships; patient concerns about treatment regimens; and the quality of relationships with providers. For instance, patients are asked the degree to which a “feeling that I will end up with serious long-term complications no matter what I do” applies to them. A two-question diabetes distress screening scale is also available.
Subjects in the study were in their mid-50s on average, the majority were white, and two-thirds were men. They had type 2 diabetes for an average of 9 years; and 20% were on insulin; the mean hemoglobin A1c was 8.7%.
The investigators have no conflicts of interest.