Relation between diabetes related distress and glycemic control: The mediating effect of adherence to treatment

• Published in: Primary care diabetes 2022-04, Vol.16 (2), p.293-300
• Main Authors: Fayed, Amel, AlRadini, Faten, Alzuhairi, Ruba Mohammed, Aljuhani, Afrah Eid, Alrashid, Hana Rashid, Alwazae, Manal Mohsen, Alghamdi, Nuha Ramadan
• Format: Article
• Language: English
• Subjects: Adherence to treatment; Diabetes related distress; Glycemic control; Mediating effect; Saudi Arabia
• ISSN: 1751-9918; 1878-0210
• DOI: 10.1016/j.pcd.2021.12.004

•Diabetes related distress is a major challenge in patients with diabetes mellitus.•Over one third of patients with DM have diabetes related distress.•Patients with type 1 DM had a higher rate of diabetes related distress and showed higher level of stress in all DRD domains.•Diabetes related distress and low adherence to treatment rates are negatively correlated with glycosylated hemoglobin. Diabetes related distress (DRD) is a negative emotional reaction to stresses associated with diabetes mellitus (DM) and its management. This study estimated the burden of DRD and self-reported adherence to treatment (SRAT) among patients with DM and investigated their relationship with glycemic control. A cross sectional study of consented 157 diabetics was conducted using the17-item Diabetes Distress Scale (DDS). It measures distress at four subscales: Emotional Burden (EB), Physician-related (PD), Regimen-related (RD) and Interpersonal Distress (ID). SRAT was assessed using Morisky’s scale. Glycemic control was assessed using the most recent HbA1c results. Multivariable linear regression analysis was used for adjustment of confounders and bootstrap Confidence Interval was used to test for the occurrence of mediating effect. Average age was 44.5 ± 16.0 years, 65% were females, 79% had type 2 DM and nearly 55% has had DM for more than 7 years and the average HbA1c was 8.9 ± 2.2%. Clinically significant DRD was reported by 37% of the participants, EB and RD in 40.8%, PD in 46.5%, and ID among 32.5%. Younger patients showed higher level of stress compared to older participants and patients with type 1 DM showed higher level of stress in all DRD domains. Only 46% of patients were defined as having satisfactory SRAT and improvement of SRAT significantly enhanced the glycemic control (r = −0.32, p < 0.01). DRD and low SRAT negatively correlated with HbA1c; increasing the DRD by one point may increase the HbA1c on average by 0.41 (C.I. 0.02–0.80) and will indirectly raise the HbA1c by 0.24 (C.I. 0.04–0.47) through the mediating effect of low SRAT. DRD and low SRAT are commonly reported among DM patients and both are indirectly correlated. The mediating effect of low SRAT highlights the clinical role of DRD and clarifies the process by which distress affect the outcome of DM management.