Diabetes-related distress and associated factors among adults with diabetes in Germany: Results of the nationwide study “Disease knowledge and information needs – Diabetes mellitus 2017”

Abstract

Background: Diabetes-related distress (DRD) can affect diabetes management adversely. In lack of population-based data, the frequency and determinants of DRD among adults with diabetes in Germany remain controversial. Methods: This study included 1367 adults with diabetes who participated in a nationwide health telephone survey conducted among German adults aged 18 years and older in 2017. The short form of the Problem Areas in Diabetes (PAID-5) scale was used to assess DRD. The associations of high DRD (PAID-5 sum score ≥ 8) with socio-demographics, diabetes-related risk factors, diabetes clinical characteristics as well as quality of self-care and chronic illness care assessed by patients were tested in multivariable logistic regression models. Results: The overall DRD prevalence was 15.1% (95% confidence intervals, 95% CIs, 12.5–18.0%) with no significant difference between men (14.7%, 95% CIs 11.2–19.1%) and women (15.4%, 11.9–19.8%). In multivariable analyses, DRD was significantly associated with younger age (odds ratio 0.96, 95% CIs 0.94–0.98, per year), immigration background (2.26, 1.16–4.42), current smoking (2.06, 1.14–3.70), insulin use (2.57, 1.45–4.56), and the presence of diabetes-specific complications (1.80, 1.10–2.94) or depressive symptoms (5.34, 3.24–8.81). Among those with depressive symptoms (18,4% of the study population), 38.3% also had DRD, which accounted for 7.0% (95% CIs 5.3–9.3%) of the study population. Conclusion: DRD is a common health problem among adults with diabetes in Germany, and highly correlates with depressive symptoms, current smoking, immigration background, and insulin use. Addressing DRD needs to become an integrative part of ambulatory diabetes care.