Abstract
Aims
To determine the point-prevalence and distribution of diabetes distress among primary
care Asians with Type 2 Diabetes Mellitus (T2DM) and evaluate its association with
cardiovascular risk.
Methods
This was a prospective, multicentre study conducted in two outpatient clinics. Patients
aged ≥ 21 years with uncontrolled T2DM (HbA1c > 7.0 % [53 mmol/mol]) and polypharmacy
were stratified based on their Framingham Risk Score (FRS–high ≥ 10 %, low < 10 %)
and matched in accordance to their baseline HbA1c. Cardiovascular risk was estimated
using FRS while diabetes distress was measured using Problem Areas in Diabetes (PAID)
scale (denial 0–10, severe distress ≥ 40).
Results
Of 1940 patients approached, 210 were recruited. A final 132 (62.9 %) participants
were eligible for analysis. Median PAID score was 17.5 (IQR 6.25–41.56), with an even
distribution in each distress category. There was no significant difference in PAID
scores between the high and low FRS groups (20.00vs13.75, p = 0.446). Additionally,
PAID score distribution within each group was similar (McNemar-Bowker test, p = 0.477).
However, a high prevalence of severe distress (31.4 %) and denial (33.8 %) was detected.
Among those in denial, 58.7 % had accompanying intermediate-high 10-year cardiovascular
risk.
Conclusion
In our sample of Asian primary care patients, a high prevalence of severe diabetes
distress and denial was detected although no clear association between cardiovascular
risk and diabetes distress was found. Future studies should assess the longitudinal
changes and impact of other risk factors in diabetes distress.
(Abstract: 199 words)
Keywords
Abbreviations:
BMI (Body mass index), CHD (Coronary heart disease), CV (Cardiovascular), DBP (Diastolic blood pressure), FRS (Framingham risk score), HbA1c (Hemoglobin A1c), HDL-c (High density lipoprotein cholesterol), HPB (Health Promotion Board), HR (Hazard ratio), IQR (Inter quartile range), LDL-c (Low density lipoprotein cholesterol), MOH (Ministry of Health), PAID (Problem Areas in Diabetes), QoL (Quality of life), SBP (Systolic blood pressure), T2DM (Type 2 Diabetes Mellitus), TC (Total cholesterol), TG (Triglyceride), WHO (World Health Organisation)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Diabetes Research and Clinical PracticeAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Mathers C, Stevens G, Mascarenhas M. Global health risks: Mortality and burden of disease attributable to select major risks. Geneva, Switzerland: World Health Organization; 2009.
- When Is Diabetes Distress Clinically Meaningful? Establishing cut points for the Diabetes Distress Scale.Diabetes Care. 2012 Feb; 35: 259-264
- Prevalence and determinants of diabetes distress in patients of diabetes mellitus in a tertiary care centre.Diabetes Metab Syndr. May 2018; 12: 333-336
- The prevalence of diabetes-specific emotional distress in people with Type 2 diabetes: a systematic review and meta-analysis.Diabet Med. 2017 Nov; 34: 1508-1520
- Depression in diabetes: have we been missing something important?.Diabetes Care. 2011; 34: 236-239
- Predicting disease distress among primary care patients with type 2 diabetes: a longitudinal study.Diabet Med. 2009; 26: 622-627
International Diabetes Federation. Diabetes Atlas. 8th ed. Belgium: IDF; 2017.
Özcan B, Rutters F, Snoek FJ, et al. High Diabetes Distress Among Ethnic Minorities Is Not Explained by Metabolic, Cardiovascular, or Lifestyle Factors: Findings From the Dutch Diabetes Pearl Cohort. Diabetes Care. 2018 Jun, dc172181.
- Cultural Differences in Psychological Distress Between Asian and Caucasian American College Students.J Multicultural Counsell Dev. 1993 Jul; 21: 182-190
Singapore Residents By Age Group, Ethnic Group And Gender, End June, Annual. [Accessed on 23 Mar 2019] Available from https://data.gov.sg/dataset/resident-population-by-ethnicity-gender-and-age-group?view_id=8ff89d3f-48c8-46e4-8a4d-a8b9f152976f&resource_id=f9dbfc75-a2dc-42af-9f50-425e4107ae84.
- Factors associated with diabetes-related distress over time among patients with T2DM in a tertiary hospital in Singapore.BMC Endocr Disord. 2017 Jun; 17: 36
Primary Care Survey 2014. Health Information Division. Ministry of Health, Singapore.
- Phobic anxiety and risk of coronary heart disease and sudden cardiac death among women.Circulation. 2005; 111: 480-487
- Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review.J Am Med Assoc. 2011; 306: 1241-1249
- Psychological Distress and Cardiovascular Disease.J Clin Outcomes Manage: J Clin Outcomes. 2015 Sep; 22: 421-431
- What predicts depression in cardiac patients: sociodemographic factors, disease severity or theoretical vulnerabilities?.Psychol Health. 2011; 26: 619-634
- The time has come for physicians to take notice: the impact of psychosocial stressors on the heart.Am J Med. 2009; 122: 704-712
- Matters of the heart: advancing psychological perspectives on cardiovascular diseases.Perspect Psychol Sci. 2013; 8: 676-678
- The impact of an acute cardiac event on the partners of patients: A systematic review.Health Psychol Rev. 2009; 3: 1-84
- Persistent depression affects adherence to secondary prevention behaviors after acute coronary syndromes.J General Internal Med. 2006; 21: 1178-1183
- Comorbid depression and health-related quality of life in patients with coronary artery disease.J Psychosom Res. 2007; 62: 401-410
- Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis.Psychosom Med. 2004; 66: 802-813
- Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis.Psychosom Med. 2004; 66: 814-822
- Target for control in Diabetes Mellitus.Singapore Family Physician. 2008; 34: 21-23
- Clinical depression versus distress among patients with type 2 diabetes: not just a question of semantics.Diabetes Care. 2007; 30: 542-548
- REDEEM: A Pragmatic Trial to Reduce Diabetes Distress.Diabetes Care. 2013 Sep; 36: 2551-2558
Ministry of Health, Singapore. MOH Clinical Practice Guidelines – Diabetes Mellitus 1/2014. [Accessed on 5 Jan 2019].
Ministry of Health, Singapore. MOH Clinical Practice Guidelines – Lipids 2/2016. [Accessed on 5 Jan 2019].
- Psychometric Properties of the Problem Areas in Diabetes (PAID) Instrument in Singapore.PLoSONE. 2015 Sep; 10: e0136759
- Psychometric properties of the Chinese version of the Problem Areas in Diabetes scale (SG-PAID-C) among high-risk polypharmacy patients with uncontrolled type 2 diabetes in Singapore.J Diabetes Invest. 2017 Mar; 8: 235-242
- Examining the Problem Areas In Diabetes scale (MY-PAID-20) among Malay T2DM patients.Int J Biol Biomed Eng. 2014 Jan; 8: 157-163
- How to screen for depression and emotional problems in patients with diabetes: Comparison of screening characteristics of depression questionnaires, measurement of diabetes-specific emotional problems and standard clinical assessment.Diabetologia. 2006; 49: 469-477
Problem Areas in Diabetes (PAID) questionnaire. DAWN study. [Accessed on 12 Feb 2019] Available from http://www.dawnstudy.com/content/dam/Dawnstudy/AFFILIATE/www-dawnstudy-com/Home/TOOLSANDRESOURCES/Documents/PAID_problem_areas_in_diabetes_questionnaire.pdf.
Charan J, Biswas T. How to Calculate Sample Size for Different Study Designs in Medical Research? Indian J Psychol Med. 2013 Apr-Jun;35(2):121-6.
- Meta-analysis of perceived stress and its association with incident coronary heart disease.Am J Cardiol. 2012; 110: 1711-1716
- Age group differences in psychological distress: the role of psychosocial risk factors that vary with age.Psychol Med. 2005 Sep; 35: 1253-1263
- Factors Associated with Diabetes-related Distress: Implications for Diabetes Self-Management.Soc Work Health Care. 2014; 53: 364-381
- Psychological distress as a risk factor for cardiovascular events: pathophysiological and behavioral mechanisms.J American College Cardiol. 2008; 52: 2156-2162
- Stress and cardiovascular disease.Nat Rev Cardiol. 2012; 9: 360-370
- Measurement of psychological adjustment to diabetes with the diabetes acceptance scale.J Diabetes Complications. 2018 Apr; 32: 384-392
Kalra S, Jena BN, Yeravdekar R. Emotional and Psychological Needs of People with Diabetes. Indian J Endocrinol Metabolism. 2018 Sep-Oct;22(5):696-704.
American Diabetes Association: Denial. [Accessed on 2 Mar 2019] Available from http://www.diabetes.org/living-with-diabetes/complications/mental-health/denial.html.
- Depression and poor glycemic control: a meta-analytic review of the literature.Diabetes Care. 2000 Jul; 23: 934-942
Lustman PJ, Clouse RE. Depression in diabetic patients: the relationship between mood and glycemic control. J Diabetes Compl. 2005 Mar-Apr;19(2):113-22.
- Barriers to Optimal Control of Type 2 Diabetes in Malaysian Malay Patients. Global.J Health Sci. 2009 Oct; 1
- Predictors of diabetes distress in patients with type 2 diabetes mellitus.Int J Res Med Sci. 2014 May; 2: 631-638
- Diabetes burden and diabetes distress: The buffering effect of social support.Ann Behav Med. 2014 Oct; 48: 145-155
- The relationship between changes in depression symptoms and changes in health risk behaviors in patients with diabetes.Int J Geriatr Psychiatry. 2010 May; 25: 466-475
Article info
Publication history
Published online: February 08, 2023
Accepted:
February 5,
2023
Received in revised form:
January 29,
2023
Received:
February 12,
2020
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
