Interaction of depressive symptoms and diabetes-related distress with glycemic control in type 2 diabetic patients

Background and aims: Psychological well-being and diabetes self-management have been shown to be interdependent. However, associations between psychological symptoms and glycemic control are not quite consistent. This study was aimed at examining patterns of glycemic control in emotionally burdened subgroups versus symptom- free individuals with type 2 diabetes. Materials and Methods: A random sample of 470 type 2 diabetic patiens (aged 58± 8yrs, 52% female, with diabetes duration of 9± 6 yrs, 33% insulin treated) were assessed for depression and diabetes-related distress by using the Center for Epidemiologic Studies-Depression (CES-D) and the Problem Areas in Diabetes (PAID) scales. Relying on the standard cut offs (CES-D>16, PAID>40), four discrete subgroups were analysed: patients with severe depressive symptoms and high diabetes distress, patients with severe depressive symptoms only, patients with high diabetes-related distress only and symptom-free patients. The indicators of glycemic control, as determined by Hba1C values, were analysed at the point of psychological assessment and after one year. Pearson's correlation coefficients were used to determine univariate associations between glycemic control, disease-related and psychological variables. Analysis of covariance was used to compare glycemic control in the four groups while controlling for the disease-related variables. Results: Twelve percent of the examined patients suffered severe depressive symptoms combined with high diabetes-related distress, 10% reported severe depressive symptoms, 22% expressed high distress and 56% were symptom-free. The entire group's glycemic control was associated with diabetes duration (r=0, 14 p