Diabetes Specific Psychological Distress in Indian Subjects with Type 2 Diabetes Mellitus

Psychological distress can have a detrimental impact on diabetes management as in case of other chronic diseases . Adjustment to the disease,  impact of variable glycemic control, fear of long‑term complications are classified as “Diabetes‑specific Psychological Distress” (DSPD) which   aggravates the feelings of fear and depression and also  effect the treatment outcomes. There is a need for simple and reliable  tools in clinical practice to screen for DSPD. The aim of this study was to establish the prevalence of DSPD among type 2 diabetes subjects using the PAID-5 questionnaire.

Methods:

This out-patient, cross sectional study included 278 adult participants  with type 2 diabetes mellitus with duration  > 1 year. Patients with history of a psychiatric disorder were excluded. Detailed clinical, anthropometric and biochemical data were collected during a routine visit . A health care assistant explained and helped the participants to complete Problem Areas in Diabetes-5 (PAID-5) questionnaire. PAID-5 is a short version of original PAID-20 questionnaire and it has 5 items with response from 0 (not a problem) to 4 (serious problem). A score of 8 or more is suggestive of DSPD requiring further evaluation.

Results:

Mean age of the participants was 44.7 ± 8.7 years. Among the 278 participants  138 (47.5% ) were females.  Out of all the participants 86 had the  PAID-5 score of 8 or more thereby  indicating the prevalence of DSPD to be  30.9%. Mean score was higher in women (6.78 ± 5.16) than in men (5.67 ± 4.81)(p-0.01).  DSPD had significant correlation  with duration of diabetes, Hba1c, neuropathy, nephropathy and insulin use. DSPD had no correlation with age, BMI, hypertension and cholesterol levels.

Discussion/Conclusion:

Mental health dysfunction and hyperglycaemia have a bidirectional relationship, therefore measurement of distress is crucial for optimal outcomes. Our study using PAID-5 questionnaire , identifies high prevalence of DSPD (30.9%) in  subjects with T2DM with the higher levels of distress in women.   DSPD  has significant   correlation  with duration of diabetes, Hba1c, neuropathy, nephropathy and insulin use. We have used  a five-item version of the PAID (PAID-5) which  possesses good reliability and validity. A major strength of the PAID-5 is that it takes less than 1 minute to complete, yet it has  a sensitivity rate of 95% and a specificity rate of 89%. Screening for DSPD using a  simple and convenient PAID-5  scale   can help the clinicians  to identify  and plan the appropriate management for subjects having DSPD, including referral to the concerned professional,  which can help in better patient care with improved long‑term results.