LITERATURE REVIEW 1

Social Orientation and Diabetes-Related Distress in Japanese and American Patients with
Type 2 Diabetes

Authors Kaori Ikeda1, Shimpei Fujimoto1,2, Beth Morling3, Shiho Ayano-Takahara1,

(Year) Andrew E. Carroll3, Shin-ichi Harashima1, Yukiko Uchida4, Nobuya Inagaki.

(2015)
Population Japanese and American patients with type 2 diabetes
Country (Westren & Asia)
Sample :
Japanese (n) = 149

US (n) = 50
Age (Mean) Japanese : 60.6 ± 8.6 (36 - 81)
Gender (%)
US : 60.6 ± 10.1 (33 - 82)

Gender :
Japanese : Female : 39 %, Male : 61 %

US : Female : 50 % , Male : 50 %
Measurement Diabetes related distress was measured using the Problem Areas in Diabetes scale
For Distress (PAID).

Outcome a well-validated 20-item self-report questionnaire [17]. Items are rated on a 5-

Measurement point scale ranging from 0 (not a problem) to 4 (a serious problem). Summed
scores are converted to a 0–100 scale by multiplying by 1.25.

The PAID was translated into Japanese by Ishii et al. and the Japanese version also
showed high internal consistency (Cronbach’s a = 0.93) and validity [20].

Results A positive correlation between interdependence and PAID (r = 0.18; P = 0.025)

and a negative correlation between perceived emotional support and PAID (r =2
0.24; P = 0.004) were observed after adjustments for other factors in Japanese data
(n = 149), but not in American data (r = 0.00; P = 0.990, r = 0.02; P = 0.917,
respectively, n = 50). In Japanese data, the three-factor structure of PAID (negative
feelings about total life with diabetes, about living conditions with diabetes, and
about treatment of diabetes) was identified, and interdependence showed
significant positive correlations with the first and second factors and perceived
emotional support showed significant negative correlations with all three factors of
PAID.
 Note Diabetes-related distress is a psychosocial issue known to impact health outcomes:
it is independently associated with self-management behaviors and perceived
burden of diabetes and also predicts future glycemic control.

LITERATURE REVIEW 2

Comparative study of the influence of diabetes distress and depression on treatment

adherence in Chinese patients with type 2 diabetes: a cross-sectional survey in the People’s
Republic of China.

Authors Jie Zhang1 Cui-ping Xu2 Hong-xia Wu2 Xiu-juan Xue2 Ze-jun Xu3 Yan Li4 Qing
(Year) Gao2 Qing-zhi Liu5

(2013)

Population 200 type 2 diabetic patients from two public hospitals

Country (Westren & Asia)
Republic of China (Asia)
Age (Mean) Years Mean : 59
Gender (%)
Men : 96 (48%)
Women : 104 (52%)

Measurement Chinese Version of Diabetes Distress Scale (CDDS)

For Distress

Outcome The Chinese version of the Diabetes Distress Scale (CDDS) was developed by
Measurement
translating the original Diabetes Distress Scale13 into Chinese.14 The reliability
and validity of the CDDS had been validated in the People’s Republic of China,15
and our own research has shown this test to have good reliability, with a
Cronbach’s alpha of 0.903.

The CDDS is a 17-item instrument representing the distress experienced over the
previous month using a Likert scale, with each item scored from 1 (no distress) to
6 (serious distress) and comprising four subscales, ie, emotional burden (five
items), physician-related distress (four items), regimen-related distress (five items),
and interpersonal diabetes-related distress (three items).
Results In the 200 eligible patients, the incidence of depression and diabetes distress was
approximately 24% and 64%, respectively. The mean score on the RADQ was
23.0 ± 6.0. Multiple regression analysis showed that DDS scores (β = 5.34, P =
0.000), age (β = 0.15, P = 0.014), and family history (β = 3.2, P = 0.016) had a
 positive correlation with depression.

DDS scores (β = −2.30, P = 0.000) and treatment methods (β = −0.93, P = 0.012)

were risk factors for poor treatment adherence, whereas age (β = 0.089, P = 0.000)
and cohabitation (β = 0.93, P = 0.012) increased treatment adherence. The
independent-samples t-test showed that depression also affected treatment
adherence (t = 2.53, P , 0.05).
Note Diabetes distress is defined as patient concern about disease management, support,
emotional burden, and access to care,4 and has been considered as part of a more
global approach to the psychologic issues associated with diabetes

LITERATURE REVIEW 3

Ethnic Minorities with Diabetes Differ in Depressive and Anxiety Symptoms and Diabetes-
Distress

Authors Charlotte B. Schmidt,1,2 Bert Jan Potter van Loon,3 Bart Torensma,4 Frank J.
(Year) Snoek,2,5,6 and Adriaan Honig1,7

(2017)

Population Diabetes outpatient clinic of the Onze Lieve Vrouwe Gasthuis OLVG),
Country (Westren & Asia) Amsterdam, the Netherlands. The clinic serves a population of 1500 patients, with
approximately 30% having a non-Dutch ethnic background.

Europe

Age (Mean) Mean age (SD) : 58.5 (14.0)

Gender (%)
Men : 315 (55.3%)
Women : 255 (44.7%)

Measurement the Dutch version of the PAID5 (Problem Areas in Diabetes Short Form)
For Distress

Outcome The PAID5 consists of 5 items (items 3, 6, 12, 16, and 19) derived from the
Measurement PAID20. These 5 items pertain to worrying about the future and risk of
complications, feeling scared or feeling depressed when thinking of diabetes,
feeling diabetes is taking up toomuch of mental and physical energy, and coping
with complications.

The items are measured on a 5-point Likert scale, scoring from 0 to 4 in which 0
stands for “not a problem” and 4 stands for “a serious problem.” A higher score
 indicatesmore diabetes-distress. A cut-off score of 8, out of a maximum of 20, was
used to indicate elevated diabetes-distress.
Results Of 1007 consecutive patients approached, 575 participated. Forty-nine percent
were of non-Dutch ethnicity and 24.7% had type 1 diabetes. Diabetes-distress was
reported by 12.5% of the native Dutch patients and by 22.0%, 34.5%, and 42.6%
of the Surinamese, Turkish, and Moroccan patients, respectively.

Prevalence of depressive symptoms was 9.4% in native Dutch patients and 20.4%,
34.5%, and 27.3% in the other groups mentioned.

Diabetes-distress and Moroccan origin were significantly associated (OR = 3.60, 𝑝

< .01) as well as depressive symptoms and Turkish origin (OR = 4.23, 𝑝 = .04).

Note Diabetes-distress, defined as emotional distress directly associated with diabetes

mellitus and its treatment

LITERATURE REVIEW 4

Association of diabetes-related distress, depression, medication adherence, and health-related

quality of life with glycated hemoglobin, blood pressure, and lipids in adult patients with type
2 diabetes: a cross-sectional study.

Authors Boon-How Chew1 Mohd-Sidik Sherina2 Noor-Hasliza Hassan3

(Year)
(2015)

Population three Malaysian public health clinics

Country (Westren & Asia)
Asia

Age (Mean) Mean age (SD) : 56,9 (10.18)

Gender (%)
Men : 329 (47%)
Women : 368 (53%)

Measurement DRD was measured using the validated DDS (Diabetes Distress Scale)
For Distress

Outcome This instrument assesses problems and difficulties concerning diabetes during the
Measurement previous month on a Likert scale from 1 (not a problem) to 6 (a very serious
problem).8,27 The DDS-17 yields a total diabetes distress scale score plus four
subscale scores that address different types of distress, ie, emotional burden,
 physician-related distress (PD), regimen-related distress, and diabetes-related
interpersonal distress.8 A local translation and validation study of the Malay
version of the DDS-17 showed high internal consistency (Cronbach’s α=0.94), and
the test-retest reliability value was 0.33 (P=0.009).

Results DRD correlated with systolic BP (r= -0.16); depressive symptoms correlated with
low-density lipoprotein cholesterol (r=0.12) and total cholesterol (r=0.13);
medication adherence correlated with HbA1c (r= -0.14) and low-density
lipoprotein cholesterol (r= -0.11); and HRQoL correlated with casual blood
glucose (r= -0.11), high-density lipoprotein cholesterol (r= -0.13), and total
cholesterol (r= -0.08). Multivariable analyses showed that HRQoL was
significantly associated with casual blood glucose (adjusted B= -0.06, P=0.024);
DRD was associated with systolic BP (adjusted B= -0.08, P=0.066); depressive
symptoms were associated with low-density lipoprotein cholesterol (adjusted
B=0.02, P=0.061), and medication adherence was associated with HbA1c
(adjusted B= -0.11, P=0.082) and total cholesterol (adjusted B= -0.06, P=0.086).
There were significant and distinctive associations of DRD, depressive symptoms,
HRQoL, and medication adherence with glycemia, BP, and lipid biomarkers.

Note DRD is defined as patient concerns about disease management, support, emotional
burden, and access to care, and is distinctively different from depression, which is
not disease-specific or context-specific to diabetes care

LITERATURE REVIEW 5

Distress and Diabetes Treatment Adherence: A Mediating Role for Perceived Control

Authors Jeffrey S. Gonzalez1,2, Erica Shreck1, Christina Psaros3, and Steven A. Safren
(Year)
(2015)

Population Adults with type 2 diabetes recruited from the Diabetes Center and Primary Care
Country (Westren & Asia) clinics at Masssachusetts General Hospital

American

Age (Mean) Mean age (SD) : 55,95

Gender (%)
Men : 55,6%
Women : 44,4%
 Measurement DRD - Emotional distress related to the burdens of diabetes and its treatment was
For Distress evaluated with the Diabetes Distress Scale (DDS) (Polonsky et al., 2005)

Outcome The DDS is a 17-item questionnaire assessing the experience of distress associated
Measurement with diabetes over the past month across four subscales: emotional burden,
physician-related distress, regimen-related distress, and interpersonal distress
(Polonsky et al., 2005).

Results Perceived control was an important mediator for both medication adherence and
A1C outcomes. Specifically, regression analyses demonstrated that diabetes
distress, but not depression severity, was significantly related to medication
adherence and A1C.

Self-efficacy and perceived control were also independently associated with

medication adherence and A1C. Mediation analyses demonstrated a significant
indirect effect for diabetes distress and medication adherence, through perceived
control and self-efficacy. The relationship between distress and A1C was
accounted for by an indirect effect through perceived control.

Note -

LITERATURE REVIEW 6

Diabetes-Related Distress and Depressive Symptoms Are Not Merely Negative over a 3-Year
Period in Malaysian Adults with Type 2 Diabetes Mellitus Receiving Regular Primary
Diabetes Care

Authors Boon-How Chew1, 2*, Rimke C. Vos 2, Rebecca K. Stellato2 and Guy E. H. M.
(Year) Rutten2

(2017)

Population Adults with type 2 Diabetes Mellitus from one public health clinics in Malaysia
Country (Westren & Asia)
Asia

Age (Mean) Mean age (SD) : 60.6 (10.14)

Gender (%)
Men : 45,2%
Women : 54,8%
Measurement DRD was measured using the 17 – item Diabetes Distress Scale (DDS) (Polonsky
For Distress et al., 2005)

Outcome DDS-17 yields a total scale score plus four sub-scale scores: emotional burden,
Measurement physician distress, regimen distress and interpersonal distress, with mean scores
ranging between 1 and 6, with higher scores representing more DRD (Polonsky et
al., 2005).
Results More symptoms of depression at baseline was the only significant and independent
predictor of improved DRD at 3 years (adjusted b = −0.06, p = 0.002). Similarly,
worse DRD at baseline was the only significant and independent predictor of fewer
depressive symptoms 3 years later (adjusted b = −0.98, p = 0.005).

Note DRD is defined as a patient’s concern about disease management, support,

emotional burden and access to care (Polonsky et al., 2005)