Aims: To characterize the determinants of diabetes-related emotional distress by treatment modality (diet only, oral medication only, or insulin). Methods: A total of 815 primary care patients with Type 2 diabetes completed the Problem Areas in Diabetes (PAID) Scale and other questions. We linked survey data to a diabetes clinical research database and used linear regression models to assess the associations of treatment with PAID score. Results: PAID scores were significantly higher among insulin-treated (24.6) compared with oral-treated (17.8, P < 0.001) or diet-treated patients (14.7, P < 0.001), but not different between oral- vs. diet-treated patients (P = 0.2). Group scores remained similar, but the statistical significance of their differences was reduced and ultimately eliminated after sequential adjustment for diabetes severity, HbA1c, body mass index, regimen adherence, and self-blood-glucose monitoring. Insulin-treated patients reported significantly higher distress than oral- or diet-treated patients on 16 of 20 PAID items. 'Worrying about the future' and 'guilt/anxiety when ... off track with diabetes' were the top two serious problems (PAID ≥ 5) in all treatment groups. Not accepting diabetes diagnosis was a top concern for oral- and diet-treated patients, and unclear management goals distressed diet-treated patients. Conclusions: Primary care patients treated with insulin reported higher diabetes-related emotional distress compared with oral- or diet-treated patients. Greater distress was largely explained by greater disease severity and self-care burdens. To improve diabetes-specific quality of life, clinicians should address patients' sense of worry and guilt, uncertain acceptance of diabetes diagnosis, and unclear treatment goals.

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Diabetic Medicine: journal of diabetes UK
Erasmus MC: University Medical Center Rotterdam

Delahanty, L. M., Grant, R. W., Wittenberg, E., Bosch, R., Wexler, D. J., Cagliero, E., & Meigs, J. (2007). Association of diabetes-related emotional distress with diabetes treatment in primary care patients with Type 2 diabetes. Diabetic Medicine: journal of diabetes UK, 24(1), 48–54. doi:10.1111/j.1464-5491.2007.02028.x