Exploring correlates of diabetes-related stress among adults with Type 1 diabetes in the T1D exchange clinic registry

Diabetes Res Clin Pract. 2018 Apr;138:211-219. doi: 10.1016/j.diabres.2017.10.012. Epub 2017 Oct 28.


Aims: To explore relations between diabetes-related stress and multiple sociodemographic, diabetes health, other health, and treatment-related variables among a large sample of adults with Type 1 Diabetes (T1D).

Methods: The sample consisted of 10,821 adults (over 18 years old) enrolled in the T1D Exchange Clinic Registry. The T1D Exchange clinic network consists of 67 diabetes clinical centers throughout the United States selected to broadly represent pediatric and adult patients with T1D. Variables were assessed through participant self-report and extraction of clinic chart data. Univariate and multiple linear regression (with simultaneous entry of all predictors) analyses were conducted.

Results: Robustly associated with increased diabetes-related stress across analyses were multiple sociodemographic (female [vs. male], native Hawaiian/other Pacific islander [vs. white/Caucasian], decreased age and diabetes duration), diabetes health (higher HbA1c), other health (lower general health, presence of major life stress and depression, less physical activity), and treatment related variables (use of injections/pen or combination injection/pen/pump [vs. pump], use of CGM, increased frequency of missing insulin doses and BG checking, decreased frequency of BG checking prior to bolus, receipt of mental health treatment).

Conclusions: We replicated and extended research demonstrating that diabetes-related stress among people with T1D occurs at higher levels among those with particular sociodemographic characteristics and is associated with a range poorer diabetes health and other health variables, and multiple treatment-related variables. The strong incremental prediction of diabetes-related stress by multiple variables in our study suggests that a multi-variable, personalized approach may increase the effectiveness of treatments for diabetes-related stress.

Keywords: Distress; HbA1c; Stress; Type 1 diabetes.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Ambulatory Care Facilities / statistics & numerical data*
  • Depression / epidemiology
  • Depression / etiology
  • Depressive Disorder / epidemiology*
  • Depressive Disorder / etiology
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / drug therapy
  • Diabetes Mellitus, Type 1 / epidemiology*
  • Diabetes Mellitus, Type 1 / psychology*
  • Female
  • Glycated Hemoglobin A / analysis
  • Humans
  • Insulin / administration & dosage
  • Insulin / therapeutic use
  • Insulin Infusion Systems
  • Male
  • Middle Aged
  • Registries* / statistics & numerical data
  • Stress, Psychological / epidemiology
  • Stress, Psychological / etiology
  • United States / epidemiology
  • Young Adult


  • Glycated Hemoglobin A
  • Insulin