Diabetes-specific emotional distress in people with Type 2 diabetes: a comparison between primary and secondary care

• Published in: Diabetic medicine Vol. 31; no. 10; pp. 1252 - 1259
• Main Authors: Stoop, C. H., Nefs, G., Pop, V. J., Wijnands-van Gent, C. J. M., Tack, C. J., Geelhoed-Duijvestijn, P. H. L. M., Diamant, M., Snoek, F. J., Pouwer, F.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01-10-2014; Blackwell; Wiley Subscription Services, Inc
• Subjects: Aged; Biological and medical sciences; Cardiovascular Diseases - complications; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Diabetes; Diabetes Complications - epidemiology; Diabetes Complications - prevention & control; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - psychology; Diabetes Mellitus, Type 2 - therapy; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - epidemiology; Diabetic Angiopathies - prevention & control; Diabetic Cardiomyopathies - epidemiology; Diabetic Cardiomyopathies - prevention & control; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Glycated Hemoglobin A - analysis; Health Care Surveys; Humans; Hyperglycemia - prevention & control; Male; Medical research; Medical sciences; Middle Aged; Models, Psychological; Netherlands - epidemiology; Prevalence; Primary care; Primary Health Care; Psychiatric Status Rating Scales; Secondary Care; Stress, Psychological - epidemiology; Stress, Psychological - etiology; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Netherlands; Endocrinopathy; Type 2 diabetes; Obesity; Secondary; Nutrition; Primary health care; Nutrition disorder; Metabolic diseases; Emotional disorder; Psychological distress; Endocrinology; Nutritional status; Comparative study
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12472

Aims
To compare levels of diabetes distress in people with Type 2 diabetes treated in primary and secondary care and to examine demographic and clinical correlates that may explain potential differences in levels of distress between care settings.
Methods
People with Type 2 diabetes from 24 primary care practices (n = 774) and three secondary care clinics (n = 526) completed the Problem Areas In Diabetes questionnaire. Data on HbA1c levels and diabetes complications were derived from medical charts. Hierarchical ordinal regression analysis was used to investigate which correlates could explain the potential differences in level of diabetes distress between care settings.
Results
Diabetes distress levels and the prevalence of elevated diabetes distress were considerably lower in the participants treated in primary care (mean (sd) total diabetes distress score 8 (11); 4% of participants with a Problem Areas In Diabetes score ≥ 40) than in secondary care (mean (sd) total diabetes distress score 23 (21); 19% of participants with a Problem Areas In Diabetes score ≥ 40, P < 0.001). In addition to care setting, the following variables were also independently related to diabetes distress: younger age, ethnic minority status, using insulin, having a higher HbA1c level, having a higher BMI and the presence of neuropathy. Other diabetes complications were not independently associated with diabetes distress.
Conclusions
In primary care, lower levels of diabetes distress were reported than in secondary care. The difference in diabetes distress between care settings can be largely, but not fully, explained by specific demographic and clinical characteristics. These results need to be interpreted with caution as they are based on two separate studies, but do call into question the need to screen for diabetes distress in people with Type 2 diabetes in primary care.
What's new?
This study shows that considerably lower levels of diabetes distress are experienced by people with Type 2 diabetes treated in primary care compared with those treated in secondary care.
These differences may be largely, but not fully, explained by demographic and clinical factors such as ethnicity and glycaemic control. Interestingly, having complications was barely related to diabetes distress.
The low prevalence of diabetes distress in primary care calls into question the need to screen for emotional distress in all people with Type 2 diabetes in primary care.