title: Exploring trajectories of diabetes distress in adults with type 2 diabetes; a latent class growth modeling approach.
abstract: BACKGROUND
  Moderate to severe diabetes distress (DD) is a common comorbidity among adults with type 2 diabetes. Cross-sectional studies find DD is strongly correlated with poor diabetes management, however little is known about the pattern of change of DD symptoms over long periods of time. We sought to identify and describe a set of distinct longitudinal trajectories of DD over 4 years of follow-up time.
  
  
  METHODS
  We used data derived from the Evaluation of Diabetes Treatment study (2011-2014), a longitudinal community-based survey of Canadian adults (40-75 years) with type 2 diabetes (n=1135). To determine the number and shape of trajectories, we used a latent class growth modeling approach.
  
  
  RESULTS
  Five distinct trajectories of DD were identified. Trajectories 1 and 2 comprised participants with persistently low (61%) or persistently low, but at risk (22%) levels of distress. Trajectory 3 (7.5%) included participants with decreasing moderate levels of distress. Trajectory 4 (6.5%) consisted of participants with increasing moderate levels of distress. Trajectory 5 (2.4%) included participants with persistently severe levels of distress.
  
  
  CONCLUSIONS
  Different populations may produce different DD trajectories and thus the generalizability of the strata identified in this report remains to be investigated. Future research is needed to determine the extent to which time-varying covariates might alter the path of DD trajectories.
  
  
  CONCLUSIONS
  For most individuals, DD is a fairly stable condition over 4 years of follow-up time. However, for a subset of individuals, DD symptoms worsened over time. Medical health professionals might consider repeated screenings for DD in adults with type 2 diabetes.
authors.affiliation: Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montreal, Quebec, Canada H4H 1R3; Department of Epidemiology and Biostatistics, McGill University, 1020 Pine Avenue West, Montreal, Quebec, Canada H3A 1A2. Electronic address: carla.lipscombe@gmail.com.
authors.forename: Carla
authors.initials: C
authors.lastname: Lipscombe
authors.affiliation: Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montréal, Quebec, Canada H3A 1A1; Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montreal, Quebec, Canada H4H 1R3.
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Burns
authors.affiliation: Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montréal, Quebec, Canada H3A 1A1; Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montreal, Quebec, Canada H4H 1R3; Department of Epidemiology and Biostatistics, McGill University, 1020 Pine Avenue West, Montreal, Quebec, Canada H3A 1A2; Montréal Diabetes Research Centre, 900, Saint-Denis, Montreal, Quebec, Canada H2X 0A9. Electronic address: norbert.schmitz@douglas.mcgill.ca.
authors.forename: Norbert
authors.initials: N
authors.lastname: Schmitz
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: Diabetes distress; Mental health; Psychological comorbidities; Type 2 diabetes