A new study, published here in Diabetic Medicine by Dr Danielle Hessler and colleagues, investigates the associations between diabetes-specific distress and key type 1 diabetes management outcomes over time.
In total, 224 adults with type 1 diabetes participated, which involved baseline and 9-month follow up survey completion and clinical data collection.
Analyses conducted examined the 1) cross-sectional, 2) prospective, and 3) temporal associations between diabetes-specific distress and indicators of diabetes self-management: HbA1c, self-reported number of hypoglycaemic events in the past week and the percentage of insulin boluses skipped in the past 2 weeks.
Consistent with prior research, significant positive correlations were observed at baseline between distress and HbA1c and insulin bolus omission. Prospective analyses revealed that greater distress at baseline was significantly associated with increased insulin bolus omission at 9 months. Additional analyses revealed that the reverse was not true – i.e. baseline insulin omission did not predict change in distress – suggesting a potential causal link. Hessler and colleagues emphasise the need for additional longitudinal research, including sophisticated change modelling, to provide further evidence of this link and guide intervention development.
Over the course of the 9-month study, analyses demonstrated a significant co-varying association between distress and HbA1c, whereby increases in distress were associated with increases in HbA1c. The authors suggest that changes are likely cyclical, with each construct influencing the other over time. Significant co-varying relationships were not observed for frequency of hypoglycaemia or insulin omission.
Due to the known potential overlap between diabetes-specific distress and depressive symptoms, all analyses were repeated using measures of depressive symptoms and Major Depression Disorder. No significant relationships were observed between depression and diabetes management at baseline, or over time. These results add weight to recent academic calls to distinguish between the constructs of diabetes-specific distress and depression among people with diabetes.
Study findings highlights the importance of screening and addressing diabetes-specific distress within clinical care as a component of diabetes management.
Hessler DM, Fisher L, Polonsky WH, Masharani U, Strycker LA, Peters AL, Blumer I, Bowyer V. Diabetes distress is linked with worsening diabetes management over time in adults with type 1 diabetes. Diabetic Medicine, in press. doi: 10.1111/dme.13381