title: Work-related diabetes distress among Finnish workers with type 1 diabetes: a national cross-sectional survey.
abstract: BACKGROUND
  Diabetes distress is common among people with type 1 diabetes, but knowledge is scarce regarding the perceived burden of reconciling work with this disease. This cross-sectional study investigated work-related diabetes distress among Finnish workers with type 1 diabetes.
  
  
  METHODS
  A questionnaire was mailed to 2500 randomly sampled 18- to 65-year-old Finns with type 1 diabetes; 49.3 % responded. Work-related diabetes distress was measured by combining worry and exhaustion in reconciling work with diabetes. Self-perceived work-related diabetes distress was evaluated in the context of physical and psychosocial work conditions, job demands, work ability, general stress, diabetes acceptance, glycosylated hemoglobin (HbA1c) level, high blood glucose maintenance at work, and depressive symptoms. The data were analyzed with the use of cross-tabulation, chi-square tests, ANOVA analysis, Spearman correlation coefficients, and structural equation modeling.
  
  
  RESULTS
  Of the respondents, 70 % experienced work-related diabetes distress. Problems with physical work conditions (β = 0.27), work ability (β = -0.21), difficulty in accepting diabetes (β = 0.18), and job demands (β = 0.14) were found to be associated with work-related diabetes distress. This distress was strongly associated with the maintenance of a high blood glucose level at work (β = 0.34). In turn, a high blood glucose level at work was associated with a high HbA1c level (β = 0.29). Work-related diabetes distress and depressive symptoms had a bi-directional association (β = 0.06 and β = 0.14). Difficulty accepting diabetes had three-dimensional associations: work-related diabetes distress (β = 0.18), depressive symptoms (β = 0.13), and high HbA1c level (β = 0.12). There was no notable association between work-related diabetes distress and general stress.
  
  
  CONCLUSIONS
  Work-related diabetes distress is common among workers with type 1 diabetes, and it may influence metabolic control. This stress could be prevented by adapting physical work conditions. People with type 1 diabetes should also be encouraged to pursue their full educational potential, and psychological support should be provided for those with difficulty accepting their diabetes.
authors.affiliation: School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
authors.forename: Pirjo
authors.initials: P
authors.lastname: Hakkarainen
authors.affiliation: Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Leena
authors.initials: L
authors.lastname: Moilanen
authors.affiliation: Department of Social Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Vilma
authors.initials: V
authors.lastname: Hänninen
authors.affiliation: School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
authors.forename: Jarmo
authors.initials: J
authors.lastname: Heikkinen
authors.affiliation: School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
authors.forename: Kimmo
authors.initials: K
authors.lastname: Räsänen
keywords: Blood glucose; Exhaustion; Stress; Type 1 diabetes; Work