Objectives: The psychological distress of people living with diabetes is increased and associated with poorer glycemic outcomes and self-care. We aimed to examine the frequency of depression, anxiety, and diabetes-related distress (DRD) of individuals with type 2 diabetes (T2D) in primary care (PC) and their comparative associations with clinical, self-care, and socio-demographic characteristics, testing for possible different roles on glycemic control and self-care. Methods: This is a cross-sectional study of 182 adults with a T2D diagnosis of at least six months, recruited between August 2019-March 2020 and May-October 2020, from an urban PC unit. Participants were screened for symptoms of depression (Patient Health Questionnaire-9 (PHQ-9)), anxiety (Generalized Anxiety Disorder-7 (GAD-7)), and DRD (Diabetes Distress Scale (DDS)). Clinical, self-care, and socio-demographic parameters were recorded. Results: The frequency of clinically significant symptoms of depression was 16.6%, (PHQ-9 score ⩾10), anxiety 17.7% (GAD-7 score ⩾10), and DRD 22.6% (DDS score ⩾2). All PHQ-9, GAD-7, and DDS scores intercorrelated, and higher scores were found to be associated with female gender, lower income, and prior diagnosis of depression. Higher PHQ-9 and GAD-7 scores were found to be associated with lower education, more hypoglycemia episodes, more blood glucose self-tests and antidepressant or benzodiazepine use. The retired/housewives scored significantly lower in GAD-7 and DDS compared to the unemployed participants. Higher DDS scores were associated with higher glycated hemoglobin, higher fasting plasma glucose, and insulin use. It was also noted that higher PHQ-9 scores were associated with lower uric acid levels and were significantly higher in the sedentary lifestyle group. Conclusion: DRD was associated with poorer glycemic outcomes while depressive symptoms were associated with lower physical activity perhaps sharing different roles for glycemic control and self-care. The psychological burden of individuals with T2D may be considered in PC.

Background Diabetes-related distress (DRD) is a common psychological issue of people living with diabetes. International guidelines advise to take DRD into consideration in diabetes care but evidence for Greece is scarce. In the present study we aimed to estimate the frequency of DRD as assessed by Diabetes Distress Scale (DDS) and to examine its connections with clinical and sociodemographic characteristics among patients with type 2 diabetes mellitus (T2D) in urban primary care (PC) in Greece. Methods This descriptive survey included adults with a diagnosis of T2D of at least six months under medication treatment attending a novel, public urban PC unit. Patients with other forms of diabetes, dementia, and psychosis were excluded. Patients were screened for DRD with DDS instrument and correlations were made between DRD and clinical and sociodemographic characteristics. Results In 135 eligible participants the frequency of moderate to high levels of DRD (DDS ≥ 2) was 24.4% and of high levels of DRD (DDS ≥ 3) was 7.4%. Emotional burden (EB) subscale was significantly correlated with younger age, insulin use, duration of insulin use, and the number of insulin injections per day. Longer diabetes duration showed significant correlation with DDS total, EB, and regimen distress. Participants with lower income, sedentary lifestyle, micro-vascular complications, more episodes of hypoglycaemia, and higher levels of glycated haemoglobin (HbA1c) experienced significantly higher distress. Conclusion DRD screening is important in urban PC and in more susceptible patients as those on more insulin injections per day, with longer diabetes duration, higher levels of HbA1c, lower income, sedentary lifestyle, and more episodes of hypoglycaemia.