Patient Factors Associated with Diabetes Distress among Veterans with Poorly Controlled Type 2 Diabetes

Diabetes distress (DD), the psychological distress specific to living with diabetes, is associated with poor glycemic control. This study sought to examine the association of diabetes distress with demographic, clinical, and psychosocial factors in a vulnerable population. The Diabetes Distress Scale (DDS), a validated patient questionnaire that assesses perceived problems and burdens associated with diabetes management, yields a total diabetes stress score plus 4 subscale scores: emotional burden (EB), physician distress (PD), regimen distress (RD) and interpersonal distress (ID). We conducted a cross-sectional analysis of baseline data from a randomized telehealth trial in a population of Veterans with persistently poor T2DM control (HbA1c ≥8.5) (N= 248). Multivariable linear regression models were used with baseline patient characteristics as independent variables and DD score as the dependent variable, and separate models for the 4 subscales of the DDS were created. Mean age of the cohort was 58 years (SD 8.3); 21% of patients were female, 79% non-white with 14 being Latinx/Hispanic. Prevalence of moderate to severe DD was 37.5% (mean DDS 1.19 (SD 0.82). In the multivariable model, Latinx/Hispanic ethnicity β 0.4 (95% CI: .01, 0.8) and higher HbA1c 0.1 (.01, 1.3) were associated with higher total DD. With respect to the DDS subscales, higher HbA1c 0.14 (0.1, 0.2) was associated with higher RD. Latinx/Hispanic ethnicity 0.8 (0.2, 1.3) was associated with higher ID. Use of basal insulin was associated with higher PD 0.3 (.001, 0.6). Depression was associated with higher total DD 0.1 (0.1, 0.1), EB 0.1 (0.1, 0.1), PD .02 (.001, 0.1), RD 0.1 (0.1, 0.1) and ID .05 (0.03, 0.1). The knowledge gained from this study has implications for practice, particularly in developing interventions targeting modifiable barriers, including patient attitudes and beliefs regarding treatment regimens and diagnoses and treatment of depression. Disclosure J. German: None. E. A. Kobe: None. D. Soliman: None. A. Lewinski: Consultant; Self; Otsuka America Pharmaceutical, Inc., Other Relationship; Self; PhRMA Foundation. A. S. Jeffreys: None. C. Coffman: None. D. Edelman: None. M. J. Crowley: None.