Correlates of diabetes-related distress in type 2 diabetes: Findings from the benchmarking network for clinical and humanistic outcomes in diabetes (BENCH-D) study

J Psychosom Res. 2015 Nov;79(5):348-54. doi: 10.1016/j.jpsychores.2015.08.010. Epub 2015 Sep 2.


Objective: To evaluate correlates of high diabetes-related distress (HD) among individuals with type 2 diabetes mellitus (T2DM).

Methods: The study involved a sample of patients with T2DM who filled in the Problem Areas in Diabetes questionnaire (PAID-5); a score ≥ 40 indicates HD. Additional instruments included: SF12 health survey (SF12), Well-Being Index (WHO-5), Diabetes Empowerment Scale-Short Form (DES-SF), Patient Assessment of Chronic Illness Care-Short Form (PACIC-SF), Health Care Climate-Short Form (HCC-SF), Global Satisfaction with Diabetes Treatment (GSDT), Summary of Diabetes Self-Care Activities (SDSCA-6); Barriers to Medications (BM), Perceived Social Support (PSS). Clinical data were extracted from computerized medical records. Multivariable logistic regression analyses were performed to identify correlates of HD.

Results: Of 2374 patients (mean age 65.0±10.2 years, diabetes duration 14.0±15.3 years, 59.9% males), 1429 (60.2%) had HD. Compared to patients with a PAID-5 score<40 those with HD were more often female, living alone, had a lower level of education, higher HbA1c levels, a greater perceived impact of hyperglycemic and hypoglycemic symptoms, a greater number of diabetes-related complications, lower scores of WHO-5, DES-SF, PSS, GSDT, SF-12 PCS, SDSCA-healthy diet and physical activity subscales, higher scores of BM and SDSCA-SMBG component. Multivariable analyses confirmed the relationship between HD and symptoms of hyperglycemia, levels of empowerment, global satisfaction with treatment, perception of barriers to medication, and psychological well-being. Conclusion HD is extremely common among people with T2DM, affecting almost two-thirds of patients. High levels of distress are associated with worse clinical and psychosocial outcomes and should be considered as a key patient-centered indicator.

Keywords: Diabetes related distress; Patient-centered outcomes; Quality of care; Type 2 diabetes.

MeSH terms

  • Aged
  • Benchmarking / methods*
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / psychology*
  • Diet, Diabetic
  • Educational Status
  • Female
  • Glycated Hemoglobin / analysis
  • Health Surveys
  • Humans
  • Hyperglycemia / epidemiology
  • Hyperglycemia / psychology
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Patient-Centered Care
  • Power, Psychological
  • Self Care
  • Social Support
  • Stress, Psychological / epidemiology
  • Stress, Psychological / psychology*
  • Surveys and Questionnaires
  • Treatment Outcome


  • Glycated Hemoglobin A