title: Diabetes distress from the patient's perspective: Qualitative themes and treatment regimen differences among adults with type 2 diabetes.
abstract: To explore diabetes distress in a sample of adults with type 2 diabetes, treated and not treated with insulin.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, 780 Welch Rd., Palo Alto, CA 94304, USA. Electronic address: mollyt@stanford.edu.
authors.forename: M L
authors.initials: ML
authors.lastname: Tanenbaum
authors.affiliation: Ferkauf Graduate School of Psychology, Yeshiva University, Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Ave., Rousso Building, Bronx, NY 10461, USA. Electronic address: naomiskane@gmail.com.
authors.forename: N S
authors.initials: NS
authors.lastname: Kane
authors.affiliation: Ferkauf Graduate School of Psychology, Yeshiva University, Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Ave., Rousso Building, Bronx, NY 10461, USA. Electronic address: joslyn.kenowitz@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Kenowitz
authors.affiliation: Ferkauf Graduate School of Psychology, Yeshiva University, Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Ave., Rousso Building, Bronx, NY 10461, USA; Diabetes Research Center, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461, USA. Electronic address: jeffrey.gonzalez@einstein.yu.edu.
authors.forename: J S
authors.initials: JS
authors.lastname: Gonzalez
mesh_terms: D000328:Adult; D001786:Blood Glucose; D003863:Depression / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: Diabetes distress; Diabetes mellitus; Focus groups; Insulin-treated; Qualitative methods