Diabetes distress from the patient's perspective: Qualitative themes and treatment regimen differences among adults with type 2 diabetes

J Diabetes Complications. 2016 Aug;30(6):1060-8. doi: 10.1016/j.jdiacomp.2016.04.023. Epub 2016 May 4.

Abstract

Aims: To explore diabetes distress in a sample of adults with type 2 diabetes, treated and not treated with insulin.

Methods: Six focus groups were conducted with 32 adults with type 2 diabetes, divided by treatment regimen (insulin-treated N=15; 67% female; 60% black; 46% Hispanic; M age 54; M HbA1c 73mmol/mol (8.8%); non-insulin-treated N=17; 53% female; 65% black; 13% Hispanic; M age 58; M HbA1c 55mmol/mol (7.2%)). A coding team transcribed and analyzed interviews to describe themes. Themes were then compared between groups and with existing diabetes distress measures.

Results: Participants in both groups described a range of sources of diabetes distress, including lack of support/understanding from others, difficulties communicating with providers, and distress from the burden of lifestyle changes. Insulin-treated participants described significant emotional distress related to the burden of their insulin regimen. They were more likely to report physical burden related to diabetes; to describe feeling depressed as a result of diabetes; and to express distress related to challenges with glycemic control. Non-insulin-treated participants were more likely to discuss the burden of comorbid medical illnesses.

Conclusions: Our data generate hypotheses for further study into the emotional burdens of diabetes for insulin-treated adults with type 2 diabetes and are in line with quantitative research documenting increased diabetes-related distress among insulin-treated individuals. Data describe needs, currently unmet by most models of care, for comprehensive assessment and tailored management of diabetes-related distress.

Keywords: Diabetes distress; Diabetes mellitus; Focus groups; Insulin-treated; Qualitative methods.

MeSH terms

  • Adult
  • Blood Glucose
  • Depression / epidemiology*
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / psychology*
  • Female
  • Focus Groups
  • Humans
  • Insulin / therapeutic use
  • Middle Aged

Substances

  • Blood Glucose
  • Insulin