title: Association of diabetes-related emotional distress with diabetes treatment in primary care patients with Type 2 diabetes.
abstract: OBJECTIVE
  To characterize the determinants of diabetes-related emotional distress by treatment modality (diet only, oral medication only, or insulin).
  
  
  METHODS
  A total of 815 primary care patients with Type 2 diabetes completed the Problem Areas in Diabetes (PAID) Scale and other questions. We linked survey data to a diabetes clinical research database and used linear regression models to assess the associations of treatment with PAID score.
  
  
  RESULTS
  PAID scores were significantly higher among insulin-treated (24.6) compared with oral-treated (17.8, P < 0.001) or diet-treated patients (14.7, P < 0.001), but not different between oral- vs. diet-treated patients (P = 0.2). Group scores remained similar, but the statistical significance of their differences was reduced and ultimately eliminated after sequential adjustment for diabetes severity, HbA(1c), body mass index, regimen adherence, and self-blood-glucose monitoring. Insulin-treated patients reported significantly higher distress than oral- or diet-treated patients on 16 of 20 PAID items. 'Worrying about the future' and 'guilt/anxiety when ... off track with diabetes' were the top two serious problems (PAID >or= 5) in all treatment groups. Not accepting diabetes diagnosis was a top concern for oral- and diet-treated patients, and unclear management goals distressed diet-treated patients.
  
  
  CONCLUSIONS
  Primary care patients treated with insulin reported higher diabetes-related emotional distress compared with oral- or diet-treated patients. Greater distress was largely explained by greater disease severity and self-care burdens. To improve diabetes-specific quality of life, clinicians should address patients' sense of worry and guilt, uncertain acceptance of diabetes diagnosis, and unclear treatment goals.
authors.affiliation: MGH Diabetes Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. ldelahanty@partners.org
authors.forename: L M
authors.initials: LM
authors.lastname: Delahanty
authors.forename: R W
authors.initials: RW
authors.lastname: Grant
authors.forename: E
authors.initials: E
authors.lastname: Wittenberg
authors.forename: J L
authors.initials: JL
authors.lastname: Bosch
authors.forename: D J
authors.initials: DJ
authors.lastname: Wexler
authors.forename: E
authors.initials: E
authors.lastname: Cagliero
authors.forename: J B
authors.initials: JB
authors.lastname: Meigs
mesh_terms: D000223:Adaptation, Psychological; D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy; D003927:Diet, Diabetic; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D013315:Stress, Psychological / Q000209:etiology*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin