The DOI matches its Crossref record; 52 of the 54 references it cites were found in a registry or an index.
The prevalence of diabetes‐specific emotional distress in people with Type 2 diabetes: a systematic review and meta‐analysis
Open accessAbstract
Aims: Psychological comorbidity, such as depression and/or diabetes‐specific emotional distress (diabetes distress), is widespread in people with Type 2 diabetes and is associated with poorer treatment outcomes. Although extensive research into the prevalence of depression has been conducted, the same attention has not been given to diabetes distress. The aim of this systematic review was to determine the overall prevalence of diabetes distress in people with Type 2 diabetes. Methods: Seven databases were searched to identify potentially relevant studies; eligible studies (adult population aged > 18 years with Type 2 diabetes and an outcome measure of diabetes distress) were selected and appraised independently by two reviewers. Multiple fixed‐ and random‐effects meta‐analyses were performed to synthesize the data; with primary analyses to determine the overall prevalence of diabetes distress in people with Type 2 diabetes, and secondary meta‐analyses and meta‐regression to explore the prevalence across different variables. Results: Fifty‐five studies ( n = 36 998) were included in the meta‐analysis and demonstrated an overall prevalence of 36% for diabetes distress in people with Type 2 diabetes. Prevalence of diabetes distress was significantly higher in samples with a higher prevalence of comorbid depressive symptoms and a female sample majority. Conclusions: Diabetes distress is a prominent issue in people with Type 2 diabetes that is associated with female gender and comorbid depressive symptoms. It is important to consider the relationship between diabetes distress and depression, and the significant overlap between conditions. Further work is needed to explore psychological comorbidity in Type 2 diabetes to better understand how best to identify and appropriately treat individuals.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“However, the demanding character of daily self-management imposes a significant burden on patients with T2DM. Adopting new healthier habits, along with the need for constant blood glucose monitoring and medication adherence, often leads to increased emotional distress and feelings of being overwhelmed [6,11-13].”
From Evaluation of the Impact of Mobile Health App Vitadio in Patients With Type 2 Diabetes: Randomized Controlled Trial (2025) · cites this paper as [11]
Experimental — accuracy not yet measuredIn the citing paper
“People with diabetes are more likely to suffer from clinically significant psychological disorders than those without the disease 1 , 2 , 3 , 4 .”
From Effects of mindfulness-based intervention on glycemic control and psychological outcomes in people with diabetes: a systematic review and meta-analysis (2021) · cites this paper as [2]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763
The Prevalence of Comorbid Depression in Adults With Diabetes
Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2001) · Diabetes Care · doi:10.2337/diacare.24.6.1069 · Cited by 3,926
Systematic reviews: CRD's guidance for undertaking reviews in health care
Tacconelli, E. (2010) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(10)70065-7 · Cited by 3,270
Transformations Related to the Angular and the Square Root
Freeman, M. F., & Tukey, J. W. (1950) · The Annals of Mathematical Statistics · doi:10.1214/aoms/1177729756 · Cited by 2,634
Metaprop: a Stata command to perform meta-analysis of binomial data
Nyaga, V. N., Arbyn, M., & Aerts, M. (2014) · Archives of Public Health · doi:10.1186/2049-3258-72-39 · Cited by 2,139
Depression and poor glycemic control: a meta-analytic review of the literature.
Lustman, P. J., Anderson, R. J., Freedland, K. E., de Groot, M., Carney, R. M., & Clouse, R. E. (2000) · Diabetes Care · doi:10.2337/diacare.23.7.934 · Cited by 1,854
Assessing Psychosocial Distress in Diabetes
Polonsky, W. H., Fisher, L., Earles, J., Dudl, R. J., Lees, J., Mullan, J., & Jackson, R. A. (2005) · Diabetes Care · doi:10.2337/diacare.28.3.626 · Cited by 1,575
Assessment of Diabetes-Related Distress
Polonsky, W. H., Anderson, B. J., Lohrer, P. A., Welch, G., Jacobson, A. M., Aponte, J. E., & Schwartz, C. E. (1995) · Diabetes Care · doi:10.2337/diacare.18.6.754 · Cited by 1,497
Ali, S., Stone, M. A., Peters, J., Davies, M. J., & Khunti, K. (2006) · Diabetic Medicine · doi:10.1111/j.1464-5491.2006.01943.x · Cited by 1,311
Self-citationDepression and Diabetes Treatment Nonadherence: A Meta-Analysis
Gonzalez, J. S., Peyrot, M., McCarl, L. A., Collins, E. M., Serpa, L., Mimiaga, M. J., & Safren, S. A. (2008) · Diabetes Care · doi:10.2337/dc08-1341 · Cited by 1,060
Fisher, L., Mullan, J. T., Arean, P., Glasgow, R. E., Hessler, D., & Masharani, U. (2010) · Diabetes Care · doi:10.2337/dc09-1238 · Cited by 681
The link between depression and diabetes: the search for shared mechanisms
Moulton, C. D., Pickup, J. C., & Ismail, K. (2015) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(15)00134-5 · Cited by 670
The problem areas in diabetes scale: an evaluation of its clinical utility
Welch, G. W., Jacobson, A. M., & Polonsky, W. H. (1997) · Diabetes Care · doi:10.2337/diacare.20.5.760 · Cited by 664 · cited 1×
“For studies reporting the PAID scale as their outcome measure, the cut-off point was set at 40 as this is deemed high and has discriminative validity [25,26].”
BackgroundWhen Is Diabetes Distress Clinically Meaningful?
Fisher, L., Hessler, D. M., Polonsky, W. H., & Mullan, J. (2012) · Diabetes Care · doi:10.2337/dc11-1572 · Cited by 648 · cited 2×
“Elevated levels of diabetes-distress appear to be widespread with estimates given by leading authors varying from between 18% to 35% [7,28] in combined Type 1 DM and Type 2 DM populations, with a recent systematic review and meta-analysis looking into the prevalence of diabetes-distress in research populations demonst…”
BackgroundDepression in diabetic patients
Lustman, P. J., & Clouse, R. E. (2005) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2004.01.002 · Cited by 613
Depression, Self-Care, and Medication Adherence in Type 2 Diabetes
Gonzalez, J. S., Safren, S. A., Cagliero, E., Wexler, D. J., Delahanty, L., Wittenberg, E., Blais, M. A., Meigs, J. B., & Grant, R. W. (2007) · Diabetes Care · doi:10.2337/dc07-0158 · Cited by 579
Holt, R. I. G., de Groot, M., & Golden, S. H. (2014) · Current Diabetes Reports · doi:10.1007/s11892-014-0491-3 · Cited by 552
Critical appraisal of the health research literature: prevalence or incidence of a health problem.
Loney, P., Chambers, L. W., BENNETT, K. J., Roberts, J. G., & Stratford, P. W. (1998) · PubMed · Cited by 550
Diabetes and depression: Global perspectives
Egede, L. E., & Ellis, C. (2010) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2010.01.024 · Cited by 549
Fisher, L., Skaff, M. M., Mullan, J. T., Arean, P., Glasgow, R., & Masharani, U. (2008) · Diabetic Medicine · doi:10.1111/j.1464-5491.2008.02533.x · Cited by 524
Identity Dilemmas of Chronically Ill Men
Charmaz, K. C. (1994) · Sociological Quarterly · doi:10.1111/j.1533-8525.1994.tb00410.x · Cited by 511
Fisher, L., Gonzalez, J. S., & Polonsky, W. H. (2014) · Diabetic Medicine · doi:10.1111/dme.12428 · Cited by 470
Clinical Depression Versus Distress Among Patients With Type 2 Diabetes
Fisher, L., Skaff, M. M., Mullan, J. T., Arean, P., Mohr, D., Masharani, U., Glasgow, R., & Laurencin, G. (2007) · Diabetes Care · doi:10.2337/dc06-1614 · Cited by 465
Constructs of depression and distress in diabetes: time for an appraisal
Snoek, F. J., Bremmer, M. A., & Hermanns, N. (2015) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(15)00135-7 · Cited by 449
Self-citationSnoek, F. J., Pouwer, F., Welch, G. W., & Polonsky, W. H. (2000) · Diabetes Care · doi:10.2337/diacare.23.9.1305 · Cited by 444
Self-citationMcGuire, B. E., Morrison, T. G., Hermanns, N., Skovlund, S. E., Eldrup, E., Gagliardino, J. J., Kokoszka, A., Matthews, D. R., Pibernik-Okanović, M., Rodríguez‐Saldaña, J., et al. (2009) · Diabetologia · doi:10.1007/s00125-009-1559-5 · Cited by 428
Self-citationUnderstanding the sources of diabetes distress in adults with type 1 diabetes
Fisher, L., Polonsky, W. H., Hessler, D. M., Masharani, U., Blumer, I., Peters, A. L., Strycker, L. A., & Bowyer, V. (2015) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2015.01.012 · Cited by 414
Gender equity in health: debates and dilemmas
Doyal, L. (2000) · Social Science & Medicine · doi:10.1016/s0277-9536(00)00072-1 · Cited by 341
Feltz-Cornelis, C. M. V. D., Nuyen, J., Stoop, C. H., Chan, J. C. N., Jacobson, A. M., Katon, W. J., Snoek, F. J., & Sartorius, N. (2010) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2010.03.011 · Cited by 339
Self-citationHermanns, N., Kulzer, B., Krichbaum, M., Kubiak, T., & Haak, T. (2006) · Diabetologia · doi:10.1007/s00125-005-0094-2 · Cited by 324
Depression in diabetes: have we been missing something important?
Gonzalez, J. S., Fisher, L., & Polonsky, W. H. (2011) · Diabetes Care · doi:10.2337/dc10-1970 · Cited by 302
Responsiveness of the Problem Areas In Diabetes (PAID) questionnaire
Welch, G. E., Weinger, K., Anderson, B. J., & Polonsky, W. H. (2003) · Diabetic Medicine · doi:10.1046/j.1464-5491.2003.00832.x · Cited by 264
Predicting diabetes distress in patients with Type 2 diabetes: a longitudinal study
Fisher, L., Mullan, J. T., Skaff, M. M., Glasgow, R. E., Arean, P., & Hessler, D. (2009) · Diabetic Medicine · doi:10.1111/j.1464-5491.2009.02730.x · Cited by 235
Distress and type 2 diabetes-treatment adherence: A mediating role for perceived control.
Gonzalez, J. S., Shreck, E., Psaros, C., & Safren, S. A. (2014) · Health Psychology · doi:10.1037/hea0000131 · Cited by 202
Katon, W. J., Simon, G. E., Russo, J. E., Korff, M. V., Lin, E. H. B., Ludman, E. J., Ciechanowski, P. S., & Bush, T. M. (2004) · Medical Care · doi:10.1097/00005650-200412000-00009 · Cited by 199
Snoek, F. J., Kersch, N. Y. A., Eldrup, E., Harman‐Boehm, I., Hermanns, N., Kokoszka, A., Matthews, D. R., McGuire, B. E., Pibernik-Okanović, M., Singer, J., et al. (2011) · Diabetes Care · doi:10.2337/dc10-1552 · Cited by 184
Self-citationVan Bastelaar, K. M. P., Pouwer, F., Geelhoed‐Duijvestijn, P. H. L. M., Tack, C. J., Bazelmans, E., Beekman, A. T., Heine, R. J., & Snoek, F. J. (2010) · Diabetic Medicine · doi:10.1111/j.1464-5491.2010.03025.x · Cited by 174
Self-citationContributors to Depression in Latino and European-American Patients With Type 2 Diabetes
Fisher, L., Chesla, C. A., Mullan, J. T., Skaff, M. M., & Kanter, R. A. (2001) · Diabetes Care · doi:10.2337/diacare.24.10.1751 · Cited by 170
SCHMITT, A. J., Reimer, A., Kulzer, B., Haak, T., Ehrmann, D., & Hermanns, N. (2015) · Diabetic Medicine · doi:10.1111/dme.12887 · Cited by 163
Should we screen for emotional distress in type 2 diabetes mellitus?
Pouwer, F. (2009) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2009.214 · Cited by 155
Prevalence of depression and diabetes: a population‐based study from rural Bangladesh
Asghar, S., Hussain, A., Ali, S. M. K., Khan, A. K. A., & Magnusson, A. (2007) · Diabetic Medicine · doi:10.1111/j.1464-5491.2007.02136.x · Cited by 136
Pouwer, F., Beekman, A. T. F., Lubach, C. H. C., & Snoek, F. J. (2005) · Patient Education and Counseling · doi:10.1016/j.pec.2005.01.009 · Cited by 133
Self-citationPouwer, F., Skinner, T. C., Pibernik-Okanović, M., Beekman, A. T. F., Cradock, S., Szabo, S., Metelko, Ž., & Snoek, F. J. (2005) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2005.03.031 · Cited by 96
Self-citationIdentity Dilemmas of Chronically Ill Men
Charmaz, K. C. (1995) · Sage eBooks · doi:10.4135/9781452243757.n13 · Cited by 95
Monitoring of Individual Needs in Diabetes (MIND)-2
Snoek, F. J., Kersch, N. Y. A., Eldrup, E., Harman‐Boehm, I., Hermanns, N., Kokoszka, A., Matthews, D. R., McGuire, B. E., Pibernik-Okanović, M., Singer, J., et al. (2012) · Diabetes Care · doi:10.2337/dc11-1326 · Cited by 80
Self-citationDiabetes-Related Symptom Distress in Association With Glucose Metabolism and Comorbidity
Adriaanse, M. C., Pouwer, F., Dekker, J. M., Nijpels, G., Stehouwer, C. D. A., Heine, R. J., & Snoek, F. J. (2008) · Diabetes Care · doi:10.2337/dc08-1074 · Cited by 56
Self-citationAdriaanse, M. C., Dekker, J. M., Spijkerman, A. M. W., Twisk, J. W. R., Nijpels, G., van der Ploeg, H. M., Heine, R. J., & Snoek, F. J. (2005) · Quality of Life Research · doi:10.1007/s11136-004-0028-3 · Cited by 48
Self-citationReliability and validity of the Icelandic version of the problem area in diabetes (PAID) scale
Sigurðardóttir, Á. K., & Benediktsson, R. (2006) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2006.10.008 · Cited by 44
Dennick, K., Sturt, J. A., Hessler, D., Purssell, E., Hunter, B. M., Oliver, J., & Fisher, L. (2015) · International Diabetes Nursing · doi:10.1080/20573316.2016.1202497 · Cited by 41
Hudson, D., Karter, A. J., Fernández, A., Parker, M. M., Adams, A. S., Schillinger, D., Moffet, H. H., Zhou, J., & Adler, N. E. (2013) · PubMed · Cited by 22
Flagged first, then by citations
2 of the 54 references couldn’t be matched to a known paper.
Research works printed but not linked: 2
- World Health Organization, 2017, WHO Member States: Six Regions
- 10.1016/S1056-8727(04)00004-2 · DOI
Cited by
Sorted by citations
Firth, J., Siddiqi, N., Koyanagi, A., Siskind, D., Rosenbaum, S., Galletly, C., Allan, S., Caneo, C., Carney, R., Carvalho, A. F., et al. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30132-4 · Cited by 1,531
Sex differences in type 2 diabetes
Kautzky-Willer, A., Leutner, M., & Harreiter, J. (2023) · Diabetologia · doi:10.1007/s00125-023-05891-x · Cited by 624
Japanese clinical practice guideline for diabetes 2019
Araki, E., Goto, A., Kondo, T., Noda, M., Noto, H., Origasa, H., Osawa, H., Taguchi, A., Tanizawa, Y., Tobe, K., et al. (2020) · Diabetology International · doi:10.1007/s13340-020-00439-5 · Cited by 545
Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., Hooks, B., Isaacs, D., Mandel, E. D., Maryniuk, M. D., et al. (2020) · Diabetes Care · doi:10.2337/dci20-0023 · Cited by 500
Twenty‐five years of diabetes distress research
Skinner, T. C., Joensen, L. E., & Parkin, T. (2019) · Diabetic Medicine · doi:10.1111/dme.14157 · Cited by 402
Metadata
- Authors
- Perrin, N. E., Davies, M. J., Robertson, N., Snoek, F. J., & Khunti, K.
- Affiliations
- University of Leicester (GB)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Corresponding author
- Perrin, N. E.
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2017-08-31
- Volume
- 34
- Issue
- 11
- Pages
- 1508-1520
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- OpenAlex
- W2742497804
- Cited by
- 495
- References
- 54
- Citations by year
- 2026: 62 · 2025: 62 · 2024: 73 · 2023: 68 · 2022: 70 · 2021: 64 · 2020: 52 · 2019: 31 · 2018: 11 · 2017: 1
- FWCI
- 3.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- Funders
- University Hospitals of Leicester NHS Trust
- National Institute for Health and Care Research
- University of Leicester
- Loughborough University
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- diabetes distress, type 2 diabetes, prevalence, depression, psychological comorbidity, depressive symptoms, sex differences, female gender
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Depression, Diabetes Mellitus, Type 2, Humans, Middle Aged, Stress, Psychological, Prevalence, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
