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Diabetes Distress

Management of diabetes as a patient can be a complex and often overwhelming task at hand. It involves many factors including regular exercise, food preparation, blood glucose monitoring, medication scheduling and planning, and numerous doctor visits. Incorporating all these elements into daily life can be a challenge.  This can lead to frustration and distress which can be noted as a psychosocial disorder known as diabetes distress. With nearly half of US adults with diabetes failing to meet the recommended targets, it is also shown diabetes distress affects close to 45% of people with diabetes1

It is essential to note however that diabetes distress is not a psychiatric disorder but rather, a broad affective reaction to the stress of living with this chronic and complex disease1. This distress can often lead to a negative effect in adherence to a self-care regimen, often leading to worsening glycemic control and increasing morbidity.  

The four leading foci of diabetes distress: 

  1. Frustration with the demands of self-care 
  1. Apprehension about the future and potential for complications 
  1. Concern about both the quality and the cost of required medical care 
  1. Perceived lack of support from family and friends 

Diabetes distress can be measured with several different scales including some that focus on quality of life and general well-being as well as diabetes-specific problems. Some of the commonly used measures of diabetes distress include: 

Diabetes Distress Scale (DDS) 

Diabetes distress score 2 

Problem Areas in Diabetes Questionnaire (PAID) 

Patients with diabetes mellitus have to watch what they eat, make special efforts to increase activity, monitor their glucose readings and at the same time deal with day-to-day life matters.  A patient with diabetes may feel like juggling four balls at once every single day while dealing with unexpected variables  at a moment’s notice.  For this reason, it can be easier for patients to develop negative habits that may hinder health performance. In this case, skipping blood sugar checks or eating unhealthy foods. This can impact hemoglobin A1C levels and can possibly lead to serious complications. This is why having accurate and up-to-date diabetes distress scales is so important for treament of diabetic patients. Specifically targeting areas causing high levels of stress can improve health and benefit the patient tremendously.  

Diabetes distress can be easily assessed using one of several patient-reported outcome measures. Some of theses tests include the Problem Areas in Diabetes, or PAID, questionnaire which is a 20-item screen for a range of feelings on diabetes. Another known as the Diabetes Distress Scale, or DDS, is 17-item measure that can assess emotional burden, physician-related stress and interpersonal stress. Most of these questionnaires or assessments help identify the main problem areas and come up with specific solutions for that particular patient. Using problem-solving therapy and cognitive behaviorial interventions for patients can provide help and relief for patients struggling with diabetes distress.  

Patients with moderate-to-high distress scores as well as individual items patients highlight as “serious” can represent clinical red flags that should lead the focus for careful discussion during a medical examination or visit. Patients can also be referred to a therapist trained in cognitive behavorial therapy or problem-solving therapy if they have moderate or  high stress. 

Overall, diabetes as a disease can be an exhausting and overwhelming health condition. However, most diabetic patients are also struggling with diabetes distress, a generalized and negative reaction to the stress of living with diabetes. With improved scales to measure this distress, treatment options can develop so that these patients are not left behind in both their physical and mental health. 

*Special thanks to Mr. Bilal Haque & Ms. Kristen Letry  for their vital role in preparing this document 

This information is for general knowledge & is not a substitute for medical advice from your doctor. 

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