There is a high prevalence of diabetes distress in young adults with type 2 diabetes, suggests the TODAY2 study published in the journal Diabetes Care.¹

This study evaluated the prevalence of diabetes distress in 438 young adults with youth-onset type 2 diabetes with women comprising 66% of the study population. Their mean age was 26.8 years. The study participants were sourced from the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY2) study.

Diabetes distress was measured using the Diabetes Distress Scale (DDS) at end-of-study visits between April 2019 and January 2020. “This questionnaire examines types of distress using four subscales: emotional burden (feeling overwhelmed, fearful), regimen distress (feeling badly about not managing diabetes well), interpersonal distress (receiving insufficient support from family/friends), and physician distress (worries about health care provider expertise and support).” Presence of depressive and anxiety symptoms was assessed using the Patient Health Questionnaire 8 (PHQ-8) and the Generalized Anxiety Disorder 7 (GAD-7) questionnaire.

Based on the information provided, overall 105 (24%) young adults with youth-onset type 2 diabetes, largely female, were found to have high diabetes distress with DDS score ≥2. Those who were hypertensive and were diagnosed with retinopathy also reported high distress as did the participants who were on insulin, had poorly controlled diabetes (higher HbA1c) and had moderate to severe depressive and anxiety symptoms.

Subscale analysis revealed 40% with high regimen distress and 29.7% with high emotional burden. High emotional burden was more prevalent in patients on insulin, while moderate to severe depressive symptoms showed an association with high regimen distress and emotional burden. Women participants had higher regimen related diabetes distress and emotional burden and also overall higher distress.

Diabetes distress encompasses “the negative feelings and emotional burdens associated with living with the challenges and demands of diabetes, including feeling burned out, overwhelmed, anxious, defeated, and depressed”.¹ The TODAY2 study has characterized diabetes distress and the major contributory factors in young adults with youth-onset type 2 diabetes. The results of the study suggest a high prevalence of diabetes distress in nearly one-quarter of the population examined.

Since type 2 diabetes is a lifestyle disorder, self-management is the cornerstone of diabetes treatment. Factors hampering self-care may cause inadequate glycemic control with early onset of diabetes-related complications and reduced quality of life. All patients with type 2 diabetes, particularly young adults, should therefore be regularly evaluated for signs and symptoms of distress associated with their disease or depression/anxiety, especially “when treatment targets are not met and/or at the onset of diabetes complication”.²

The American Diabetes Association (ADA) recommends that this evaluation should be done “at the initial visit, at periodic intervals, and when there is a change in disease, treatment, or life circumstance” in its latest Standards of Medical Care in Diabetes -2022. Besides patients, caregivers and family members should also be included in the assessment.² These patients should be referred for timely appropriate counselling and specific management.

References

1. Trief PM, et al. Diabetes distress in young adults with youth-onset type 2 diabetes: TODAY2 study results. Diabetes Care. 2022 Jan 11;dc211689. doi: 10.2337/dc21-1689.
2. Boris Draznin, et al. 5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022 Jan 1;45(Supplement_1):S60-S82. doi: 10.2337/dc22-S005.