Basal insulin does not contribute to emotional distress in type 2 diabetes, study finds

A randomized trial found no evidence that basal insulin affected emotional distress and indicated that insulin glargine and liraglutide were associated with a modest decrease in diabetes-related distress at one year.

Glucose-lowering medications added to metformin were linked with overall decreases in emotional distress in patients with type 2 diabetes, a study found.

In the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE), adults with early type 2 diabetes and an HbA1c level of 6.8% to 8.5% who were taking metformin monotherapy were randomized to add insulin glargine U-100, glimepiride, liraglutide, or sitagliptin. The Emotional Distress Substudy (EDS) began more than halfway into recruitment, enrolled 1,739 GRADE participants willing to use injection therapy, and assessed diabetes distress and depressive symptoms every six months.

Diabetes distress was assessed with the 17-item Diabetes Distress Scale, with mean scores ranging from one to six, and a score of two or greater indicating clinically significant diabetes distress. Depressive symptoms were measured with the 8-item Patient Health Questionnaire, with scores ranging from 1 to 24 and higher scores indicating greater severity. Analyses examined differences at one year and over three years of follow-up. Results were published by Diabetes Care on Feb. 28.

Across all treatment groups, diabetes distress and depressive symptoms decreased over one year from baseline (difference, −0.24 and −0.67, respectively; P<0.0001 for both comparisons). Diabetes distress was lower at one year for the glargine group than for the other groups combined (difference, −0.10; P=0.002) and was also lower for liraglutide than for glimepiride or sitagliptin (difference, −0.10; P=0.008). Over the three-year follow-up, no significant between-group differences were noted in total diabetes distress, and interpersonal diabetes distress remained lower for those assigned to liraglutide. No significant differences were observed for depressive symptoms.

The authors concluded that contrary to their expectations, diabetes distress and depressive symptoms remained below baseline throughout the three-year follow-up, despite increasing treatment with a second glucose-lowering medication. They noted that diabetes distress was more sensitive to treatment differences than depressive symptoms and that statistically significant differences between treatment groups were limited to aspects of emotional distress related to diabetes self-management and diabetes-related support received from friends and family.

"Our results highlight the distinctions between diabetes distress and depressive symptoms, which shared only 21% of their variance in the current study, and the benefits of assessing diabetes distress to identify treatment-related stressors that may contribute to emotional distress (e.g., 'Feeling that I am often failing with my diabetes routine') and can and should be addressed as part of diabetes care," the authors wrote.