title: Diabetes-related burden and distress in people with diabetes mellitus at primary care level in Germany.
abstract: OBJECTIVE
  The importance of diabetes-related distress for the treatment of diabetes is emphasised in national and international guidelines recommending routinely screening for psychosocial problems. Data of investigations regarding diabetes-related distress on primary care are rare in Germany though most people with diabetes are treated without insulin therapy at primary care level.
  
  
  METHODS
  Three hundred and forty-five people with diabetes mellitus type 2 (DM2, n = 336, 229 without and 107 with insulin therapy) and type 1 (DM1, n = 9) were interviewed with the PAID questionnaire in the period from 1 October 2015 to 31 December 2015 in a general practice. A PAID score ≥40 (range 0-100) was considered as high diabetes-related distress.
  
  
  RESULTS
  The mean PAID score of all participants was 3.9 ± 7.0 (DM2 without insulin 2.7 ± 6.3, DM2 with insulin therapy 6.0 ± 8.0, DM1 6.8 ± 4.9) and far below the threshold of 40 points. Only 1.2% of all responders showed high diabetes-related distress (score ≥40). People on insulin therapy with HbA1c >7.5% and with diagnosed depression prior to the study scored significantly higher. Furthermore, there are weak correlations between the PAID score and HbA1c (r = 0.253, p < 0.001), duration of diabetes (r = 0.169, p = 0.002), insulin dosage (r = 0.283, p < 0.001) and age (r = -0.129, p = 0.016).
  
  
  CONCLUSIONS
  Only 1.2% of our outpatients with diabetes on primary care level showed high diabetes-related distress. Higher rates in the current literature are probably due to not investigating on primary care level. Guidelines should consider this.
authors.affiliation: Department of Internal Medicine III, Endocrinology and Metabolic Disorders, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany. nadine.kuniss@med.uni-jena.de.
authors.forename: N
authors.initials: N
authors.lastname: Kuniss
authors.affiliation: General Practice, Saalfeld, Thuringia, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Rechtacek
authors.affiliation: Department of Internal Medicine III, Endocrinology and Metabolic Disorders, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kloos
authors.affiliation: Department of Internal Medicine III, Endocrinology and Metabolic Disorders, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany.
authors.forename: U A
authors.initials: UA
authors.lastname: Müller
authors.affiliation: Department of Internal Medicine III, Endocrinology and Metabolic Disorders, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Roth
authors.affiliation: Department of Internal Medicine III, Endocrinology and Metabolic Disorders, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Burghardt
authors.affiliation: Department of Internal Medicine III, Endocrinology and Metabolic Disorders, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Kramer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Diabetes-related distress; PAID questionnaire; Type 2 diabetes