title: Diabetes-related distress over the course of illness: results from the Diacourse study.
abstract: OBJECTIVE
  To investigate the relationship between diabetes duration and diabetes-related distress and to examine the impact of micro- and macrovascular complications and blood glucose-lowering treatment on this relationship.
  
  
  METHODS
  We conducted a cross-sectional study in people with Type 2 diabetes who participated in the Dutch Diacourse study (n = 590) and completed the Problem Areas in Diabetes questionnaire. Data on diabetes duration, micro- and macrovascular complications and blood glucose-lowering treatment were collected. Multiple linear regression analysis was used to investigate the association between diabetes duration and diabetes-related distress, and to examine whether complications and treatment could explain this association.
  
  
  RESULTS
  A significant linear and quadratic association between diabetes duration and diabetes-related distress was found (duration: β = 0.27, P = 0.005; duration(2): β = -0.21, P = 0.030). The association between duration and distress could be explained by microvascular complications and insulin treatment, which were both more often present in people with a longer diabetes duration, and were associated with higher levels of diabetes-related distress (β = 0.20, P < 0.001 and β = 0.16, P = 0.006 respectively). Duration, age, gender, complications and treatment together explained 13.1% of the variance in distress.
  
  
  CONCLUSIONS
  Diabetes duration was associated with diabetes-related distress. This association can be explained largely by the presence of diabetes-related microvascular complications and insulin treatment. Healthcare providers should focus on distress in people with Type 2 diabetes in different stages over the course of illness, especially when complications are present or when people are on insulin treatment. As well as diabetes duration, complications and blood glucose-lowering treatment, diabetes-related distress is likely to be influenced by many other factors.
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Kasteleyn
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: de Vries
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: A L
authors.initials: AL
authors.lastname: van Puffelen
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.|Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: F G
authors.initials: FG
authors.lastname: Schellevis
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Rijken
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands.
authors.forename: R C
authors.initials: RC
authors.lastname: Vos
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands.
authors.forename: G E H M
authors.initials: GE
authors.lastname: Rutten
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy / Q000009:adverse effects; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D003925:Diabetic Angiopathies / Q000453:epidemiology*; D003927:Diet, Diabetic / Q000009:adverse effects; D018450:Disease Progression; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009426:Netherlands / Q000453:epidemiology; D012306:Risk; D057566:Self Report; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology / Q000209:etiology*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin