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Abstract
This study examined the associations of diabetes-related distress (DRD), depressive symptoms, health-related quality of life (HRQoL), and medication adherence with glycemia, blood pressure (BP), and lipid biomarkers in adults with type 2 diabetes mellitus (T2D). This cross-sectional study was conducted in three Malaysian public health clinics in 2012–2013, recruited adult patients (aged ≥30 years) with T2D who had been diagnosed for more than one year, were on active follow-up, and had recent blood test results. Univariable and multivariable analyses were performed to identify significant associated factors for glycated hemoglobin (HbA1c) BP, and lipids. The response rate was 93.1% (700/752). The majority were females (52.8%), Malay (52.4%), and married (78.7%). DRD correlated with systolic BP (r= −0.16); depressive symptoms correlated with low-density lipoprotein cholesterol (r=0.12) and total cholesterol (r=0.13); medication adherence correlated with HbA1c (r= −0.14) and low-density lipoprotein cholesterol (r= −0.11); and HRQoL correlated with casual blood glucose (r= −0.11), high-density lipoprotein cholesterol (r= −0.13), and total cholesterol (r= −0.08). Multivariable analyses showed that HRQoL was significantly associated with casual blood glucose (adjusted B= −0.06, P=0.024); DRD was associated with systolic BP (adjusted B= −0.08, P=0.066); depressive symptoms were associated with low-density lipoprotein cholesterol (adjusted B=0.02, P=0.061), and medication adherence was associated with HbA1c (adjusted B= −0.11, P=0.082) and total cholesterol (adjusted B= −0.06, P=0.086). There were significant and distinctive associations of DRD, depressive symptoms, HRQoL, and medication adherence with glycemia, BP, and lipid biomarkers. Unexpected beneficial therapeutic effects of DRD on BP require further study. A multidisciplinary approach may be needed for risk management in adults with T2D at the primary care level.
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Acknowledgments
This study was funded by the Research University Grants Scheme 2 (RUGS/04-02-2105RU). The authors acknowledge the Sepang and Petaling district health offices and officers for their support of this study and the Director-General of Health for giving permission to publish this research. They also acknowledge the World Health Organization and Harith Khalid Al-Qazaz for use of WHOQOL-BREF and the MMAS-8 Malay version, respectively. We thank Rimke Vos of the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands, for her input into the initial draft of this manuscript. They would like to record their appreciation of Firdaus Mukhtar, Nor-Kasmawati Jamaludin, and Fuziah Paimin for their input during the planning of the study and assistance with data collection. Finally, they thank the staff at all the clinics for facilitating the data collection.
Disclosure
The authors report no competing interests in this work. The study sponsor had no role in the design or conduct of the study, the writing of this report, or the decision to submit it for publication.