Diabetes distress is linked with worsening diabetes management over time in adults with Type 1 diabetes. Issue 9 (18th June 2017)

• Record Type: Journal Article
• Authors: Hessler, D. M.; Fisher, L.; Polonsky, W. H.; Masharani, U.; Strycker, L. A.; Peters, A. L.; Blumer, I.; Bowyer, V.
• Is Part Of: Diabetic medicine. Volume 34:Issue 9(2017)
• Page Start: 1228
• Page End: 1234
• Publication Date: 2017-06-18
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13381
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aim: To determine the cross‐sectional and longitudinal associations between diabetes distress and diabetes management. Methods: In a non‐interventional study, 224 adults with Type 1 diabetes were assessed for diabetes distress, missed insulin boluses, hypoglycaemic episodes, and HbA1c at baseline and 9 months. Results: At baseline, greater distress was associated with higher HbA1c and a greater percentage of missed insulin boluses. Longitudinally, elevated baseline distress was related to increased missed insulin boluses, and decreases in distress were associated with decreases in HbA1c . In supplementary analyses, neither depression symptoms nor a diagnosis of major depressive disorder was associated with missed insulin boluses, HbA1c or hypoglycaemic episodes in cross‐sectional or longitudinal analyses. Conclusions: Significant cross‐sectional and longitudinal associations were found between diabetes distress and management; in contrast, no parallel associations were found for major depressive disorder or depression symptoms. Findings suggest that elevated distress may lead to more missed insulin boluses over time, suggesting a potential intervention target. The covarying association between distress and HbA1c points to the complex and likely interactive associations between these constructs. Findings highlight the need to address distress as an integral part of diabetes management in routine care. What's new?: The current study builds on a small body of work focused on diabetes distress for persons living with Type 1 diabetes. The longitudinal finding that elevated baseline diabetes distress predicts a worsening in missed insulin boluses suggests that diabetes distress may play a causative role in its impact on management; identifying an additional target for intervention. Significant covarying longitudinal associations between increases in diabetes distress and HbA1c over time mirror findings from the Type 2 diabetes literature and indicate an interactive relationship between these key constructs.