Study reveals toll of diabetes distress on blood sugar control in type 1 diabetes

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A new study has found that greater diabetes distress and emotional struggles among adults with type 1 diabetes are associated with higher indicators of worsening diabetes control.
The research hints at how emotions can get under the skin, so to speak, to significantly affect people’s abilities to maintain healthy HbA1c levels and undertake self-care activities, such as correctly managing insulin.
Diabetes Distress (DD) refers to all the fears and worries that people with diabetes experience on a daily basis. Fear of complications or the fear of hypoglycemia are examples of the types of concerns that may cause DD.
The researchers from UCSF School of Medicine followed 224 adults with type 1 diabetes from northern California and Ontario, Canada over nine months.
The participants were free of severe complications with baseline HbA1c levels of 56.3 mmol/mol. Some had had type 1 diabetes for over 20 years and a longer duration of diabetes is a known risk factor for elevated DD.
Participants filled in two surveys, the Diabetes Distress Scale for Adults with Type 1 diabetes (T1-DDS) and a depression-screening questionnaire, given to them for the study to keep a daily record of their emotional experiences.
The T1-DDS covers emotions across several dimensions of DD, including powerlessness, management distress, hypoglycemia distress, negative social perceptions, eating distress, physician distress and psychosocial distress.
The purpose of this survey was to identify links between diabetes control and common sources of DD, such as concerns about possible negative judgments of others, disappointment with one’s own self-care efforts or feeling worried about the future.
Researchers tested for markers of diabetes control, including HbA1c, severe hypoglycemia and missed insulin boluses, and found that higher DD led to higher HbA1c levels over 9 months and a higher probability of missing insulin boluses.
A reduction in DD at 9 months was associated with an improvement in HbA1c levels, but was not associated with a change in hypoglycemic episodes or diabetes self-care behaviours.
These outcomes may vary depending on an individual’s average ratio of positive to negative emotions, differences in demographic characteristics or personality.
For example, the findings specifically focus on middle-aged people from only two geographic areas. They need to be replicated in larger, more culturally diverse samples.
Overall, these findings highlight the need for diabetes care teams to provide emotional support when people have the greatest probability of feeling elevated levels of DD, such as around the time of diagnosis or at the time of learning how to self-manage diabetes.