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Cited by 235Diabetes Management and EducationDiabetes Management and ResearchCancer survivorship and care

Predicting diabetes distress in patients with Type 2 diabetes: a longitudinal study

Open access
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.xPMC PMC2740749
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Abstract

AIMS: Diabetes distress (DD) is a condition distinct from depression that is related to diabetes outcomes. In those without distress initially, little is known about what indicators place patients at risk for subsequent distress over time. METHODS: From a community-based, three-wave, 18-month study of Type 2 diabetic patients (n = 506), we identified patients with no DD at T1 who displayed DD at T2, T3 or both (n = 57). Using logistic regression with full and trimmed models, we compared them with patients with no DD at all three time points (n = 275) on three blocks of variables: patient characteristics (demographics, depression, extra-disease stress), biological (HbA(1c), body mass index, comorbidities, complications, blood pressure, non-high-density lipoprotein-cholesterol), and behavioural variables (diet, exercise). Selected interactions with stress and major depressive disorder (MDD) were explored. RESULTS: The odds of becoming distressed over time were higher for being female, previously having had MDD, experiencing more negative events or more chronic stress, having more complications, and having poor diet and low exercise. Negative life events increased the negative effects of both high HbA(1c) and high complications on the emergence of distress over time. CONCLUSIONS: We identified a list of significant, independent direct and interactive predictors of high DD that can be used for patient screening to identify this high-risk patient cohort. Given the impact of high DD on diabetes behavioural and biological indicators, the findings suggest the usefulness of regularly appraising both current life and disease-related stressors in clinical care.

Integrity signals

Registry

Crossref · 10.1111/j.1464-5491.2009.02730.x

Cites

14 of 14 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 10 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The effect of negative life events on +DD is greater in men than in women.

    “Furthermore, the effects of NLE on +DD were greater in men than women and in those without than with recent MDD.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Caucasian ethnicity is associated with higher odds of becoming distressed over time, with the association approaching significance.

    “Controlling for the other characteristics, the odds of becoming distressed over time were higher among younger patients, those with less education, women, Caucasians, those with previous MDD, and those experiencing NLE and/or chronic stress.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Having low exercise is associated with higher odds of becoming distressed over time.

    “The odds of becoming distressed over time were higher for being female, previously having MDD, experiencing more negative events or more chronic stress, having more complications, and having poor diet and low exercise.”
    • Also stated in: § Predictors of +DD · plain
      “Combining the results from all analyses, the odds of reaching +DD during the 18 months following initial assessment were most consistently associated with: being female, having MDD during the previous year, experiencing more NLE and more chronic stress, having high numbers of complications, and having poor diet and low exercise.”
    • Also stated in: § DISCUSSION · plain
      “We identified a core group of variables that, across analyses, were consistently predictive of +DD, with ROC statistics indicating good discriminability between groups: being female, having MDD during the previous year, experiencing more NLE and more chronic stress, having high numbers of complications, and having poor diet and low exercise.”
    Quote in the paperSubstantial claim
  • Findingown data

    Having previous MDD is associated with higher odds of becoming distressed over time.

    “The odds of becoming distressed over time were higher for being female, previously having MDD, experiencing more negative events or more chronic stress, having more complications, and having poor diet and low exercise.”
    • Also stated in: § Predictors of +DD · plain
      “Combining the results from all analyses, the odds of reaching +DD during the 18 months following initial assessment were most consistently associated with: being female, having MDD during the previous year, experiencing more NLE and more chronic stress, having high numbers of complications, and having poor diet and low exercise.”
    • Also stated in: § DISCUSSION · plain
      “We identified a core group of variables that, across analyses, were consistently predictive of +DD, with ROC statistics indicating good discriminability between groups: being female, having MDD during the previous year, experiencing more NLE and more chronic stress, having high numbers of complications, and having poor diet and low exercise.”
    Quote in the paperSubstantial claim
  • Findingown data

    Being female is associated with higher odds of becoming distressed over time.

    “The odds of becoming distressed over time were higher for being female, previously having MDD, experiencing more negative events or more chronic stress, having more complications, and having poor diet and low exercise.”
    • Also stated in: § Predictors of +DD · plain
      “Combining the results from all analyses, the odds of reaching +DD during the 18 months following initial assessment were most consistently associated with: being female, having MDD during the previous year, experiencing more NLE and more chronic stress, having high numbers of complications, and having poor diet and low exercise.”
    • Also stated in: § DISCUSSION · plain
      “We identified a core group of variables that, across analyses, were consistently predictive of +DD, with ROC statistics indicating good discriminability between groups: being female, having MDD during the previous year, experiencing more NLE and more chronic stress, having high numbers of complications, and having poor diet and low exercise.”
    Quote in the paperSubstantial claim
  • May combine two claims. 9
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 4

  • May combine two claims.

    Findingown data

    Previous MDD qualifies the relationship between time since diagnosis and +DD: among those with no MDD, longer diabetes duration is associated with lower likelihood of +DD; among those with recent MDD, longer duration is associated with somewhat higher likelihood.

    “Finally, previous MDD qualified the relationship between time since diagnosis and the emergence of +DD over time. Among those with no MDD, those who had diabetes longer were less likely to reach criteria for +DD; among those with a recent episode of MDD, those with diabetes longer were somewhat more likely to reach criteria for +DD.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Having poor diet is associated with higher odds of becoming distressed over time.

    “The odds of becoming distressed over time were higher for being female, previously having MDD, experiencing more negative events or more chronic stress, having more complications, and having poor diet and low exercise.”
    • Also stated in: § Predictors of +DD · plain
      “Combining the results from all analyses, the odds of reaching +DD during the 18 months following initial assessment were most consistently associated with: being female, having MDD during the previous year, experiencing more NLE and more chronic stress, having high numbers of complications, and having poor diet and low exercise.”
    • Also stated in: § DISCUSSION · plain
      “We identified a core group of variables that, across analyses, were consistently predictive of +DD, with ROC statistics indicating good discriminability between groups: being female, having MDD during the previous year, experiencing more NLE and more chronic stress, having high numbers of complications, and having poor diet and low exercise.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    MDD was assessed by the Composite International Diagnostic Interview, a structured clinical interview.

    “MDD was assessed by the Composite International Diagnostic Interview, 4 a structured clinical interview.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4]

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    In the combined/trimmed model, 8 of 10 variables that approached or reached significance in the initial analyses continued to reach or approach significance, with similar odds ratios.

    “Of the 10 variables that approached or reached statistical significance in the general, biological and behavioural analyses, 8 continued to reach or approach significance in the combined analysis, and the ORs remained similar across models.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Diabetes distress is significantly related to HbA1c and several disease management measures, whereas MDD and depressive affect are not significantly related to these variables in controlled analyses.

    “the analyses indicated a significant relationship between diabetes distress, HbA1c and several disease management measures, whereas no significant relationships were found in controlled analyses among MDD, depressive affect and these variables 1,3.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] source

      Not checked in the free run.

    • cites [3] source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    The Diabetes Distress Scale is a 17-item questionnaire with alpha = 0.93, and a mean-item score ≥3 was used as the distress cut-point.

    “DD was assessed by the Diabetes Distress Scale (DDS),10, 11 a 17-item questionnaire (alpha = 0.93), with a mean-item score of ≥ 3 (moderate distress, 1–5 response scale) used as the distress cut-point 12.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The stresses associated with complications, NLE, chronic stress, diet/exercise difficulties, and recent MDD each contribute independently to +DD.

    “It appears that the stresses associated with having significant complications, the demands of NLE and non disease-related chronic stress, the difficulties of effectively managing diet and exercise, and the burdens posed by a recent episode of MDD each contribute independently to +DD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The trimmed model had an AUC of .82, indicating adequate fit and excellent discrimination.

    “For each model, the ROC statistics indicated adequate fit and excellent discrimination (e.g., trimmed model AUC=.82).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    High DD, once it occurs, is a relatively persistent condition.

    “We reported previously that the point prevalence of high DD was about 18% of patients in our diverse community sample, and that high DD, once it occurs, is a relatively persistent condition (3).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Both non-diabetes-related stressors (NLE) and diabetes-related stressors (HbA1c, complications) magnify the effect of other conditions on +DD.

    “Similar patterns emerge upon review of the exploratory analyses of interactions, such that both non diabetes-related stressors (NLE) and diabetes-related stressors (HbA1c, complications) magnify the effect of other conditions on +DD.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    No multicollinearity was detected in any model.

    “No multicolinearity was detected in any model.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Differences between completers and non-completers occurred in only two of 28 comparisons: longer duration of diabetes and more often speaking Spanish.

    “Differences between completers vs. non completers occurred in only two of 28 comparisons: those who missed T2, T3 or both had longer duration of diabetes (r = 0.12, p = 0.01) and more often spoke Spanish than English (r = 0.09, p = 0.04).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Broader life context issues influence diabetes and its management directly and may interact with diabetes-specific factors to affect +DD.

    “These findings suggest that not only do broader life context issues influence diabetes and its management directly, they may also interact with diabetes-specific factors, such as HbA1c and complications, to affect +DD.”
    Quote in the paperSubstantial claim
13 of 13

  • The paper relies on this without support.

    Early identification of patients with diabetes at risk for high DD can lead to subsequent screening and follow-up care that reduces the emergence of high DD over time.

    “Early identification of patients with diabetes at risk for high DD can lead to subsequent screening and follow-up care to reduce the emergence of high DD over time.”
1 of 1

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?

  • Incorporating starting HbA1c levels from prior research and predicting a differential HbA1c change over time of 0.5% between groups yielded a Cohen's d=0.29.

    “Incorporating starting HbA1c levels from prior research in this population (1,26), and predicting differential HbA1c change over time of 0.5% between the two groups, we obtained a Cohen’s d=0.29.”

    From Addressing emotional distress to improve outcomes in adults with type 1 diabetes: Protocol for ACT1VATE randomized controlled trial (2024) · cites this paper as [26]

    The Methods (Measures and Subjects; page unavailable) say HbA1c was included as a biological variable and blood was collected at the initial assessment, but the passages found do not give starting HbA1c levels. Searches for baseline HbA1c values and Table 1 did not establish the levels the citing authors used. The proposed 0.5% difference and Cohen’s d are the citing authors’ calculation, not findings attributed to this source. (LLM, conf=0.72)

    Experimental — accuracy not yet measured

  • High levels of diabetes distress have been significantly associated with poor glycemic control, poor self-care, low diabetes self-efficacy, and poor quality-of-life, even after controlling for clinical depression.

    “High levels of DD have been significantly associated with poor glycemic control, poor self-care, low diabetes self-efficacy, and poor quality-of-life, even after controlling for clinical depression (5).”

    From When Is Diabetes Distress Clinically Meaningful? (2012) · cites this paper as [5]

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Mullan JT, 2006, The diabetes distress scale: a replication, Diabetes, 55, A426

Cited by

Sorted by citations

Related

Authors
Fisher, L., Mullan, J. T., Skaff, M. M., Glasgow, R. E., Arean, P., & Hessler, D.
Affiliations
  • University of California, San Francisco (US)
  • Kaiser Permanente (US)
Corresponding author
Fisher, L.
ORCID
Venue
Diabetic Medicine
Publisher
Wiley
Published
2009-06
Volume
26
Issue
6
Pages
622-627
ISSN
  • 0742-3071 (ISSN-L)
  • 1464-5491
DOI
10.1111/j.1464-5491.2009.02730.x
PMC
PMC2740749
OpenAlex
W1972925040
Cited by
235
References
14
Citations by year
2026: 12 · 2025: 12 · 2024: 18 · 2023: 17 · 2022: 24 · 2021: 26 · 2020: 12 · 2019: 14 · 2018: 12 · 2017: 20 · 2016: 14 · 2015: 12 · 2014: 11 · 2013: 13 · 2012: 8
FWCI
4.36
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Diabetic Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • University of California, San Francisco
  • National Institute of Diabetes and Digestive and Kidney Diseases (DK-061937, DK062732, R01DK061937, R01DK062732)
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, risk factors, major depressive disorder, chronic stress, negative life events, HbA1c, diabetes complications, diet, physical activity, screening
MeSH terms
Adult, Aged, Major Depressive Disorder, Diabetes Mellitus, Type 2, Epidemiologic Methods, Female, Humans, Male, Middle Aged, Psychometrics, Stress, Psychological, Diabetes Complications, Young Adult

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