Diabetes distress in patients with type 2 diabetes mellitus and obesity

The aim. To determine the role of obesity in the development of diabetic distress in patients with type 2 diabetes, to identify clinical and laboratory features of patients with type 2 diabetes and diabetic distress.

Material and methods. 152 patients (72 men and 80 women) with type 2 diabetes participated in the study, 76 of them were non-obese (group 1), 76 had a BMI >30 kg/m2 (group 2). The average age of patients is 51 [40; 60] years. The experience of diabetes mellitus in the studied patients is <10 years. All patients underwent the determination of HbA1c, waist circumference, diagnosis of diabetic distress using a specialized PAID questionnaire and assessment of depression using the Beck scale. Statistical data processing was carried out using the software packages Microsoft Excel 2016 and STATISTICA.

Results. Patients with type 2 diabetes and obesity have significantly more pronounced diabetic distress on the PAID scale, a higher level of depression on the Beck scale, as well as a significantly higher index of HbA1c. In the group of patients with a high probability of diabetic distress, the average level of HbA1c was significantly higher by 0.88%, and the waist circumference was 8.3 cm larger. As a result of the correlation analysis, a direct correlation was revealed between waist circumference and the number of points according to the PAID questionnaire.

Conclusion. Obesity in type 2 diabetes is a risk factor for diabetic distress and is associated with a higher risk of depression. Diabetic distress is associated with higher values of HbA1c and the severity of abdominal obesity, which worsens the control of diabetes mellitus, which means that it may indirectly increase the risk of complications. Understanding diabetic distress and effective management strategies can significantly improve the effectiveness of treatment and improve the quality of life of patients with type 2 diabetes and obesity.

1. GBD 2021 Diabetes Collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023 Jul 15;402(10397):203-234. doi: 10.1016/S0140-6736(23)01301-6. Epub 2023 Jun 22. Erratum in: Lancet. 2023 Sep 30;402(10408):1132. PMID: 37356446; PMCID: PMC10364581

2. Roy T, Lloyd CE. Epidemiology of depression and diabetes: a systematic review. J Affect Disord. 2012 Oct;142 Suppl:S8-21. doi: 10.1016/S0165-0327(12)70004-6. PMID: 23062861

3. Kreider KE. Diabetes Distress or Major Depressive Disorder? A Practical Approach to Diagnosing and Treating Psychological Comorbidities of Diabetes. Diabetes Ther. 2017 Feb;8(1):1-7. doi: 10.1007/s13300-017-0231-1. Epub 2017 Feb 3. PMID: 28160185; PMCID: PMC5306125

4. Sirirak, T.; Sangsupawanich, P.; Wongpakaran, N.; Srisintorn, W. The Geriatric Depression Scale Predicts Glycemic Control in Older Adult with Type 2 Diabetes Mellitus: A Longitudinal Study. Healthcare 2022, 10, 1990. https://doi.org/10.3390/healthcare10101990

5. Yang X, Li Z and Sun J (2020) Effects of Cognitive Behavioral Therapy–Based Intervention on Improving Glycaemic, Psychological, and Physiological Outcomes in Adult Patients With Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials. Front. Psychiatry 11:711. doi: 10.3389/fpsyt.2020.00711

6. Wondmkun YT. Obesity, Insulin Resistance, and Type 2 Diabetes: Associations and Therapeutic Implications. Diabetes Metab Syndr Obes. 2020 Oct 9;13:3611-3616. https://doi.org/10.2147/DMSO.S275898

7. Castrén E, Rantamäki T. Role of brain-derived neurotrophic factor in the aetiology of depression: implications for pharmacological treatment. CNS Drugs. 2010 Jan;24(1):1-7. doi: 10.2165/11530010-000000000-00000. PMID: 20030415

8. Casanova F, O'Loughlin J, Martin S, Beaumont RN, Wood AR, Watkins ER, Freathy RM, Hagenaars SP, Frayling TM, Yaghootkar H, Tyrrell J. Higher adiposity and mental health: causal inference using Mendelian randomization. Hum Mol Genet. 2021 Nov 30;30(24):2371-2382. doi: 10.1093/hmg/ddab204. PMID: 34270736; PMCID: PMC8643500

9. Joseph JJ, Golden SH. Cortisol dysregulation: the bidirectional link between stress, depression, and type 2 diabetes mellitus. Ann N Y Acad Sci. 2017 Mar;1391(1):20-34. doi: 10.1111/nyas.13217. Epub 2016 Oct 17. PMID: 27750377; PMCID: PMC5334212

10. Das R, Singh O, Thakurta RG, Khandakar MR, Ali SN, Mallick AK, Roy P, Bhattacharrya AK. Prevalence of Depression in Patients with Type II Diabetes Mellitus and its Impact on Quality of Life. Indian J Psychol Med. 2013 Jul;35(3):284-9. doi: 10.4103/0253-7176.119502. PMID: 24249932; PMCID: PMC3821207

11. Zhao G, Ford ES, Li C, Tsai J, Dhingra S, Balluz LS. Waist circumference, abdominal obesity, and depression among overweight and obese U.S. adults: National Health and Nutrition Examination Survey 2005-2006. BMC Psychiatry. 2011 Aug 11;11:130. doi: 10.1186/1471-244X-11-130. PMID: 21834955; PMCID: PMC3163524

12. Pouwer F, Schram MT, Iversen MM, Nouwen A, Holt RIG. How 25 years of psychosocial research has contributed to a better understanding of the links between depression and diabetes. Diabet Med. 2020 Mar;37(3):383-392. doi: 10.1111/dme.14227. Epub 2020 Jan 24. PMID: 31909844

13. Kretchy IA, Koduah A, Ohene-Agyei T, Boima V, Appiah B. The Association between Diabetes-Related Distress and Medication Adherence in Adult Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. J Diabetes Res. 2020 Mar 1;2020:4760624. doi: 10.1155/2020/4760624. PMID: 32190697; PMCID: PMC7071811