Diabetes-Related Emotional Distress Over Time

Abstract

BACKGROUND AND OBJECTIVES: Many adolescents with type 1 diabetes experience diabetes-related distress (DRD; the negative emotional reactions specific to managing diabetes), but most research on DRD among adolescents relies on cross-sectional data. We assess adolescents' longitudinal DRD patterns and predictors of chronic DRD. METHODS: This secondary analysis of data from a depression prevention clinical trial included 264 adolescents with type 1 diabetes randomly assigned to a resilience or education intervention (mean age: 15.7 6 1.1 years; 59.8% female). Youth reported their DRD at 5 assessments over 16 months. Using latent class growth analysis, we classified adolescents into trajectory groups according to baseline starting point (intercept) and rate of change (slope) of DRD. We examined bivariate associations between trajectory group membership and demographic and clinical factors. Baseline predictors of chronic DRD were assessed via multiple logistic regression. RESULTS: Participants were classified into 4 groups: stable high DRD (7.2%; high intercept, flat slope), stable moderate DRD (28.0%; above-average intercept, flat slope), improving DRD (33.7%; average intercept, downward slope), and low DRD (31.1%; below-average intercept, downward slope). Lower hemoglobin A1c, greater adherence, fewer socioemotional difficulties, and more adaptive coping distinguished the improving and low DRD trajectories. Chronic DRD patterns were associated with female sex and higher depressive symptoms and hemoglobin A1c. CONCLUSIONS: In this study of adolescents' DRD trajectories during and after a psychoeducational intervention, one-third of youth were classified as having chronic, elevated DRD. Links with multiple clinical factors support efforts for routine DRD screening and comprehensive interventions for distressed youth. WHAT'S KNOWN ON THIS SUBJECT: Diabetes-related distress (DRD), the common negative emotional reactions specific to managing diabetes, is associated with adolescents' type 1 diabetes outcomes. Yet little is known about stability or change in DRD longitudinally and what predicts these patterns in this age group. WHAT THIS STUDY ADDS: Although this study specifically sampled youth without diagnosed depression, one-third of participants experienced chronic, elevated levels of DRD over time. A sizable subset of youth may need more intensive intervention to address DRD and concomitant risk factors.

Assessing Diabetes Distress and Sleep Quality in Young Adults with Type 1 Diabetes Using FreeStyle Libre: A Prospective Cohort Study

“…Many adolescents with T1DM experience diabetes-related distress, and this condition is often associated with suboptimal glycemic control, low levels of self-care, and reduced selfefficacy [12]. Previous studies of youths with T1DM have shown that chronic diabetes-related distress is associated with higher levels of depressive symptoms and higher HbA1c levels [13,14].…”

<p>Efficacy Of Acceptance And Commitment Therapy For Emotional Distress In The Elderly With Type 2 Diabetes: A Randomized Controlled Trial</p>

“…6 In addition to physical problems such as retinopathy, nephropathy, neuropathy and diabetic foot, 7 there are higher levels of emotional problems in individuals with type 2 diabetes which include depression, anxiety, aggression and emotional distress. 8,9 According to studies, about 20% to 40% of patients with type 2 diabetes experience emotional distress. 10,11 Emotional distress in individuals with type 2 diabetes is a worry and anxiety that is related to diabetes and exists from mild to severe level.…”

Prevalence of diabetes distress and depression and their association with glycemic control in adolescents with type 1 diabetes in Dubai, United Arab Emirates

“…Another common challenge that adolescents face and that has been associated with suboptimal diabetes outcomes is diabetesrelated distress. 11 Diabetes distress refers to the fear of complications, fear of hypoglycemia, in addition to the range of stresses, strains and concerns that people who are diagnosed with diabetes have to live with on a daily basis. 12 Diabetes distress is not a proxy for clinical depression, but rather a reflection of an emotional response to a demanding health condition.…”