Prevalence and Associations of Diabetes-related Emotional Distress in People With Type 2 Diabetes at Kenyatta National Hospital

Abstract

Background: Mental wellbeing is important among those living with diabetes as it has critical impact on healthcare outcomes. Diabetes Related Distress (DRD) is the negative emotions and emotional distress arising from the challenges of living with diabetes. Concerns about diet restrictions, potential complications and strict management regimens have great effect on the emotions and well-being of individuals with diabetes. Psychological evaluation of diabetes-related distress provides insight into the prevalence and factors associated with diabetes-related emotional distress. The study’s results give healthcare professionals a broader understanding of the level of diabetes-related emotional distress experienced by people living with type 2 diabetes in our population and identifies factors associated with DRD. Understanding the extent of the problem is of great clinical benefit as it helps to identify potential deficiencies in health care services and areas in which healthcare service delivery could be improved. Objectives: This research aimed at (1) Determining the prevalence of emotional distress related to diabetes among those with diabetes type 2 in Kenyatta National Hospital. (2) Identifying factors associated to diabetes-related emotional distress. Method: This was a descriptive, cross-sectional study that was conducted at the out-patient diabetes clinic at the Kenyatta National Hospital from August to October 2020. It involved administering the Diabetes Problem Areas tool along with a demographic questionnaire to participants with type two diabetes followed by assessment of HBA1C as a measure of glycemic control in DRD. Trained research staff reached out to eligible participants (adults over 18 years of age, with type two diabetes) awaiting their scheduled clinic appointment. The nature and intent of the study was explained to them, and their participation was requested. Those who were willing to participate in the research and who met the inclusion criteria were selected to take part in the research. The Problem Area in Diabetes (PAID) questionnaire is a 20-item questionnaire that the participants fill indicating the extent to which each item is a challenge to them. Each PAID item received a score that ranged from “not a problem” (score of 0) to “serious problem” (score of 4). Scores on the 20 items were aggregated; they were then multiplied by 1.25 to generate a score between 0-100 with the higher results indicting greater diabetes-related emotional distress. A score of 11 and above was categorized as DRD 6,17 Data analysis: Descriptive statistics comprising of percentages, means, and standard deviations (SD) were used to summarize patient characteristics and outcomes. Demographic and clinical characteristics were summarized into percentages for categorical variables, while continuous data were presented as means with standard deviations or medians with interquartile ranges. PAID score of 11 and above indicated presence of DRD and the patients with this score were categorized to show prevalence presented as a percentage. Severity of DRD was also presented as percentages. Results: The study included 298 participants. Of these 201 (67.4%) were female and 97(32.6%) were male. The mean age in years was 59.1. The prevalence of diabetes-related emotional distress was 44%. Diabetes-related emotional distress was found to be more common in people who were younger [p <0.001]. Those categorized as married experienced less diabetes-related emotional distress [p= 0.014, CI 1.2-3.9]. Conclusion: The prevalence of DRD in our population is significant enough to warrant change in how healthcare is delivered to our patients with type 2 diabetes.