https://orcid.org/0000-0002-5127-5894
Abstract
Purpose
To address the prevalence of diabetes distress (DD) and its correlators in adults with type 2 diabetes.
Patients and Methods
During 2021 and 2022, we conducted a cross-sectional study in three Class A tertiary comprehensive hospitals in China, and received 947 participants who completed a printed survey covering DD, demographic, diabetic, physiological, and psychosocial factors. We used Jonckheere-Terpstra, chi-square, and Fisher’s exact tests to assess intergroup differences between different levels of DD. We used ordinal logistic regression analysis to analyze correlators of DD further.
Results
The prevalence of DD was 34.64%. In univariate analysis, those with lower satisfaction with financial status, longer durations of diabetes, more complications, higher glycemia, more severe insomnia, treatment by medications only, poorer lifestyle interventions, fewer self-care activities, more types and frequencies of insulin injections, and spending more money and time on treatment were susceptible to DD. Type D personality, negative illness perceptions, negative coping styles, and psychological effects of major life events were related to higher DD. Hope, self-efficacy, positive coping styles, and social support can reduce DD. In ordinal logistic regression analysis, hypoglycemic episode (β=−1.118, p=0.019, “have hypoglycemic” as reference) and Brief Illness Perception Questionnaire (β=0.090, p<0.001) were significant positive correlators for DD, while diet intervention (β=0.803, p=0.022, “have diet intervention” as reference), money spent on diabetes treatment (β<-0.001, p=0.035), and SES (β=−0.257, p<0.001) were significant negative correlators.
Conclusion
More than one-third of Chinese adults with type 2 diabetes experience moderate or high levels of DD. DD was associated with financial, diabetic, physiological, and psychosocial status.
Abbreviations
DD, diabetes distress; STROBE, Strengthening the Reporting of Observational Studies in Epidemiology; C-DDS17, 17-item Chinese Diabetes Distress Scale; SDSCA, Summary of Diabetes Self-Care Activities; ISI, Insomnia Severity Index; BMI, body mass index; WHR, waist-hip ratio; WHtR, waist-height ratio; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBG, fasting blood glucose; 2hPBG, 2-hour postprandial blood glucose; TC, total cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; SCr, serum creatinine; SUA, serum uric acid; ACR, urinary albumin‒creatinine ratio; DS-14, Type D Personality Scale-14; SI, social inhibition; NA, negative affectivity; HHI, Herth Hope Index; T, inner sense of temporality and future; P, inner positive readiness and expectancy; I, interconnectedness with self and others; BIPQ, Brief Illness Perception Questionnaire; SES6G, Self-Efficacy for Managing Chronic Disease Six-item Scale; SCSQ, Simplified Coping Style Questionnaire; SSRS, Social Support Rating Scale; LES, Life Event Scale; SD, standard deviation; IQR, interquartile range.
Data Sharing Statement
The data that support the findings of this study are available on request from the corresponding author YS, and the first author Y-YZ. The data are not publicly available due to ethical restrictions that their containing information could compromise the privacy of research participants.
Ethics Approval and Informed Consent
This study was approved by the Human Biomedical Research Ethics Committee of School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College (no. [2020]03), registered in the Chinese Clinical Trial Registry (no. ChiCTR2100047071), and complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. All methods were carried out following relevant guidelines and regulations.
We performed this study according to the Declaration of Helsinki. Before the formal investigation, the researcher provided and clearly explained the written informed consent to the participants. On the premise of fully understanding the informed consent and voluntarily participating in the study, the participants voluntarily signed their name (usually family name), contact information (selected), and date. Because the illiterate participants in this study could fully understand the informed consent after the researcher’s explanation and could write their names and Arabic numerals, they signed their names and left their telephone numbers (optional) on the signature page of the informed consent by themselves after listening carefully to the researcher’s explanation and fully understanding the informed consent.
Consent for Publication
The details of any texts, images and recordings can be published, and that the participants providing consent have been shown the article contents to be published.
Acknowledgments
The authors thank all study participants for spending their time on the investigation. The authors also gratefully thank the Department of Endocrinology medical staff of the Peking Union Medical College Hospital, China-Japan Friendship Hospital, and the Peking University Third Hospital for their support during data collection. Finally, the authors thank the School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College for supporting this study. The authors also would like to thank TopEdit (www.topeditsci.com) and Springer Nature (authorservices.springernature.com) for the English language editing of this manuscript.
Author Contributions
Y-YZ conceptualized and designed the study, collected, analyzed and interpreted the data, and drafted and wrote the manuscript. WL modified the conception, study design, assisted with data acquisition, analysis, and interpretation; and substantially reviewed and revised the manuscript. YS completed and supervised the whole study design, data collection, analysis and interpretation, and reviewed and revised the manuscript. QW and FZ helped modifying the study design, assisted with data collection, participated in data analysis and interpretation, and critically reviewed the manuscript. YW contributed in data acquisition and interpretation, and critically reviewed the manuscript. Y-YZ and YS are the guarantors of this work, have full access to all the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis. All aforementioned authors agreed on the journal Patient Preference and Adherence to which the article will be submitted, reviewed and agreed on all versions of the article, and agreed to take responsibility and be accountable for the contents of the article.
Disclosure
Yu Sheng is the vice-chairperson of the Disaster Nursing Committee of the Chinese Nursing Association. Fang Zhao is the chairperson of the Diabetes Nursing Committee of the Chinese Nursing Association. The authors report no other conflicts of interest in this work.