Research Article| Volume 197, 110574, March 2023

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Severe distress & denial among Asian patients with Type 2 Diabetes Mellitus in the primary care: A prospective, multicentre study

Published:February 08, 2023DOI:



      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.


      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).


      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.


      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)



      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)
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