Prevalence and determinants of diabetes distress and its association with self-management among patients living with type 2 diabetes: a cross-sectional study from a tertiary care hospital in Sri Lanka.

BACKGROUND: Diabetes distress (DD) refers to the emotional and psychological strain related to the management of diabetes and its complications. It can result in poor self-management behaviours and suboptimal health outcomes. This study aimed to evaluate the prevalence, determinants and impact of DD on self-management behaviours and glycaemic control among people with type 2 diabetes mellitus (T2DM) attending a tertiary care hospital in Sri Lanka. METHODS: A descriptive, cross-sectional study was conducted at the Diabetes and Endocrine Clinic of the National Hospital, Sri Lanka. DD was measured using the 17-item Diabetes Distress Scale (DDS-17), comprising four domains: emotional burden, physician-related, regimen-related, and interpersonal distress. Self-management was assessed using the Diabetes Self-Management Questionnaire-Revised (DSMQ-R), covering five domains: glucose monitoring, medication adherence, dietary control, physical activity and healthcare use. Both instruments were interviewer-administered. DD severity was defined as clinically significant if DDS-17 score was ≥ 2 (moderate-high level of DD). Logistic regression was used to identify determinants of DD and Spearman’s rank correlation was used to assess the associations between DD, DSMQ-R scores and glycaemic control. A p value of < 0.05 was considered statistically significant. RESULTS: Among 322 participants (mean age 59.9 ± 10.2 years; mean diabetes duration 11.4 ± 7.7 years), the prevalence of DD was 30.4% (95% CI: 25.7%–35.7%). After adjusting for confounders, determinants of DD were age range of 41–59 years (OR 3.6, 95% CI: 2.0-6.5, p < 0.001), female gender (OR 2.8, 95% CI: 1.4–5.4, p = 0.01), suboptimal glycaemic control of HbA1c ≥ 7% (OR 4.4, 95% CI: 1.9–10.1, p < 0.001) and the presence of comorbidities (OR 3.1, 95% CI: 1.3–7.3, p = 0.01). Self-management activity scores including glucose monitoring, medication adherence, dietary control, physical activity and healthcare use had significant and negative correlations with both DD and HbA1C (p < 0.05). CONCLUSIONS: Diabetes distress significantly impairs self-management and glycaemic control among people living with T2DM. Routine screening for diabetes-related distress using tools such as the DDS-17 should be integrated into diabetes care to identify patients experiencing moderate-to-high levels of distress and who are therefore at risk of poor self-management and adverse disease outcomes. CLINICAL TRIAL NUMBER: Not applicable.