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Diabetes distress tied to higher HbA1c, missed insulin doses in type 1 diabetes
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Adults with type 1 diabetes who report higher levels of diabetes distress are more likely to miss insulin boluses and have a higher HbA1c over 9 months than those with lower distress levels, according to published findings.
“The effect of high baseline distress on subsequent reductions in missed boluses is prospective and unidirectional, offering cautionary support for a possible causative linkage,” Danielle Hessler Jones, PhD, an associate professor with the UCSF School of Medicine, and colleagues wrote. “In the current study, individuals with elevated baseline distress are more likely to miss more insulin boluses at 9-month follow-up, even after controlling for baseline levels of missed insulin boluses. Interestingly, the converse directional effect does not hold: Baseline percent of missed boluses is not a predictor of distress at follow-up, controlling for baseline distress.”
Hessler Jones and colleagues analyzed data from 305 adults with type 1 diabetes without severe complications from northern California and Ontario, Canada, recruited from diabetes clinics (mean age, 43 years; 56% women; mean HbA1c, 7.3%; mean diabetes duration, 22 years). Participants completed the T1-Diabetes Distress Scale, a 28-item survey with items rated on a six-point scale (from “not a problem” to “very serious problem”), and the eight-item Patient Health Questionnaire to assess depression symptoms, with a severity score between 0 and 3 for each item. Surveys were completed again 9 months later; researchers also reviewed HbA1c at baseline and 9 months. Researchers used multiple regression analyses to examine relationships between diabetes distress with each diabetes management variable (HbA1c, incident hypoglycemia and missed insulin boluses).
Within the cohort, 224 participants (74%) completed the 9-month assessment.
In cross-sectional analyses using continuous scores or cut points, researchers found that diabetes distress was associated with both baseline HbA1c (beta = 0.28; P = .03) and percent of missed insulin boluses (beta = 0.04; P = .02) with higher levels of distress associated with worse glycemic control and a greater number of missed boluses.
In prospective analyses, diabetes distress at baseline predicted a change in percent of missed insulin boluses at 9 months (beta = 0.05; P = .006) with higher levels of baseline distress associated with a greater number of missed boluses later. However, insulin management at baseline did not predict future diabetes distress at 9 months, according to researchers. In time-varying analyses, a reduction in diabetes distress at 9 months was associated with an improvement in HbA1c (beta = 0.34; P < .01), but was not associated with a change in hypoglycemic episodes or diabetes self-management behaviors.
“To our knowledge, this is the first prospective longitudinal finding of its kind and has important implications for intervention,” the researchers wrote. “Understanding that high diabetes distress is associated with an increase in missed insulin boluses identifies a potential target for intervention. A critical next step will be to examine this association in a longitudinal research design with more than two time points, which would permit more sophisticated modelling of change and more confidence in causative conclusions.” – by Regina Schaffer
Disclosures: Hessler Jones reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.
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