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

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

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SSD Diabetology, Niguarda Ca' Granda Hospital, Milan, Italy. Electronic address:
Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
Novo Nordisk SpA, Rome, Italy.
Novo Nordisk A/S, Bagsværd, Denmark.
Diabetes Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto (AP), Italy.



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


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.


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.


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

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