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Diabetes-related distress is one of the psychological disorders affecting patients with diabetes, yet there are few studies about diabetes-related distress in Chinese patients. To assess the level of psychological distress and examine its associated factors, we conducted a cross-sectional analysis of patients with type 2 diabetes mellitus from a Chinese tertiary hospital. The Diabetes Distress Scale (DDS) and the General Self-Efficacy Scale (GSES) were administered. There were 210 (57.85%) patients with little or no diabetes-related distress, 84 (23.14%) with moderate diabetes-related distress and 69 (19.01%) with high diabetes-related distress. Stepwise multiple linear regression showed that sleep time was significantly related to the DDS total score and the subscale scores of emotional burden (EB) (β=-0.190, -0.379), respectively. GSES was associated with the DDS total score (β=-0.128) and the EB score (β=-0.153). Oral medication plus insulin was significantly related to regimen-related distress (RD) (β=0.137), physician-related distress (PD) (β=0.152) and interpersonal distress (ID) (β=0.103). Physical activity (β=-0.185) and making meal plan with health care professionals(HCP) (β=-0.169) were associated with RD. The prevalence of diabetes-related distress among patients with type 2 diabetes mellitus was high in China. DDS and EB were associated with poorer sleep time and lower self-efficacy. Interventions to improve sleep are needed. Qualitative and longitudinal studies are required to understand why type 2 diabetic patients are not getting enough sleep.

KnowledgeSelf-care a b s t r a c t Purpose: To investigate the knowledge and behaviours on foot self-care in patients with type 2 diabetes mellitus; analyse the influential factors, and provide information for the intervention study.Methods: A total of 5961 patients with type 2 diabetes mellitus from 144 hospitals in China were included in the study. The investigation content included patients' demographic data, foot self-care knowledge and behaviours. The investigation tools were the questionnaires on the general diabetes information, on the foot self-care knowledge, and on the foot selfcare behaviours.Results: The foot self-care knowledge was medium and the foot self-care behaviour was poor. The status of knowledge and behaviours were influenced by education, duration of diabetes mellitus, periodic inspection, and education about diabetic complications. Pearson analysis demonstrated that there was positive correlation between knowledge score and behaviour score (r ¼ 0.27, p < 0.001).Conclusions: The status of foot self-care knowledge and behaviours are not optimistic. According to the patients' own characteristics, the theory of knowledge, attitude and practice applies to encouraging patients to go for periodic inspection and education about diabetic complications so as to enhance the knowledge and promote the self-care behaviours.

The insulin injection skill of patients with diabetes in mainland China was poor, and the incidence of lipohypertrophy, bleeding, and needle reuse was high. Frequency of daily insulin injection and needle reuse may relate to the incidence of lipohypertrophy and bleeding. The bleeding and bruising at the injection sites may be associated with suboptimal absorption of injected insulin. Improved education in optimal insulin injection technique, including reducing needle reuse and correct rotation of injection sites should be emphasized.