Diabetes Distress Associated with Patient Factors Including HbA1c Score, Ethnicity


Data show 37.5% of patients in study were found to have moderate to severe DD, with an average score of ≥2.

Jashalynn German, MD

Jashalynn German, MD

The impact of diabetes distress (DD) can be significant for patients, with lower rates of diet adherence, physical activity, and poor glycemic control associated with worse clinical outcomes.

A recent study, presented at the 2021 American Diabetes Association Virtual Conference, investigated the relationship between DD and demographic, psychosocial and clinical factors through a self-administered questionnaire.

Investigators, led by Jashalynn German, MD, Department of Medicine, Division of Endocrinology, Duke University, found that factors such as increase in HbA1c and patients with Hispanic ethnicity led to an increase in DD scores.


The study used the Diabetes Distress Scale (DDS), with a total DD score and 4 subscale scores, including emotional burden, physician distress, regimen distress, and interpersonal distress.

An average score of <2 indicated little or no distress, while an average score of ≥2 - 2.9 reflected moderate distress and was considered clinically significant.

Further, an average score of ≥3 reflected high distress.

Investigators performed a cross-sectional analysis using baseline data from a randomized trial of veterans with poorly controlled type 2 diabetes.

The enrollment took place from December 2018 - January 2020 in Durham, NC and the VA Veteran Affairs Medical Centers in Richmond, VA.

A total of 248 patients were included, with baseline data showing demographic variables, clinical measures, DD scale, and psychosocial metrics.

Main outcomes included prevalence of DD and factors associated with an increased DD.

An analysis of the data used multivariable linear regression models including patient characteristics as independent variables and DDS scores as dependent variables.


The mean age of the study cohort was 58 years, with 21% of patients female and 79% non-white.

Investigators noted the prevalence of moderate to severe DD was 37.5%, with an average total score of ≥2. The data show the mean A1C overall was 9.76 (SD 1.53).

In addition, investigators observed in the multivariable model, Hispanic ethnicity (β 0.4; 95% CI, .01, 0.8) and higher HbA1c (β 0.1; 95% CI, .01, 1.3) had an association with a higher total DD.

Moreover, the DDS subscales showed higher HbA1c (0.14; 95% CI, 0.1, 0.2) was associated with higher regimen distress.

Furthermore, the subscales showed hispanic ethnicity (0.8; 95% CI, 0.2, 1.3) was associated with higher interpersonal distress and use of basal insulin was associated with higher physician distress (0.3; 95% CI, .001, 0.6).


Investigators concluded that an increase in HbA1c and PHQ 8 scores, use of basal insulin, and Hispanic ethnicity had associations with higher DD scores and subscale scores.

“Future applications may allow for the creation of more targeted interventions in clinical and community sectors with the goal of improving health outcomes related to Type 2 Diabetes,” investigators wrote.

The study, “Patient Factors Associated with Diabetes Distress Among Veterans with Poorly Controlled Type 2 Diabetes,” was published online by ADA.

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