Review calls for increased measurement, treatment of diabetes distress
An analysis of six studies found that an average of 78.3% of people with diabetes had at least some clinically relevant diabetes distress-related problems and that a commonly used scale does not capture most patients with distress.
A new study underscored the importance of addressing the emotional and behavioral challenges facing patients with diabetes and offered suggestions to improve the translation, adoption, and implementation of diabetes distress knowledge into clinical care.
Researchers assessed a diabetes distress translation/implementation program at one U.S. academic medical center. All adults with type 1 diabetes at the clinic were asked to complete the T1 Diabetes Distress Scale (T1-DDS). Of the 141 adults assessed, 28% reported elevated diabetes distress using the T1-DDS total score. However, 88% of patients reported clinically significant diabetes distress on at least one subpart of the scale irrespective of their total score, suggesting the total score “failed to identify 60% of people who reported significant [diabetes distress]-related problems,” the study authors wrote. Sources of elevated diabetes distress varied from person to person, indicating it is not a uniform experience, they added. The review was published Oct. 11 by Diabetic Medicine.
To assess the generalizability of these findings, the authors then compiled data from six large-scale community studies that employed the five most common measures of diabetes distress. An average of 78.3% of people with diabetes across the six studies indicated at least some clinically relevant diabetes distress-related problems. After analyzing the five distress measures, the authors concluded that because of its ubiquity, diabetes distress should not be considered a comorbidity or complication of diabetes, or as a mental health illness or condition. They also argued diabetes distress assessment should be accepted as a standard part of comprehensive care and occur regularly using broad rather than brief screening measures.
The study authors cited the precedent of the integration of emotional distress in cancer care and called for a similar approach to diabetes distress. They recommended that distress be addressed directly by diabetes clinicians as opposed to behavioral specialists exclusively. Key limitations of available diabetes distress measures include that the definition of elevated distress varies across measures, that all total or core scores are based on sums or averages of contributing items or sources, and that they do not include sources of the distress.
“The extant literature and clinical experience suggest that it is time to more fully integrate evidenced-based [diabetes distress] assessment and intervention into routine diabetes clinical care,” the authors concluded.