Publication Description
Aims: Diabetes distress (DD) is associated with poor health outcomes. Little is known about level of DD in young adults (YAs) with youth-onset type 2 diabetes (T2D) or individual factors associated with DD. Aims were to assess level of DD, and factors associated with high DD, in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) cohort. Methods: YAs completed the Diabetes Distress Scale (DDS), PHQ-9 (depressive symptoms) and GAD7 (anxiety), at the end-of-study visit. Factors that may relate to DD were demographics (sex, race/ethnicity, age, education, income), medical history (HbA1c, BMI, complications), and social/economic factors (# persons in household, parent status, healthcare coverage, access to diabetes care provider). Univariate logistic regressions found factors associated with high DD. Multivariate regression controlled for sex, HbA1c, healthcare coverage, anxiety, depressive symptoms and retinopathy. Results: Of 457 YAs, mean age=26.7 yrs, 65% were female, 20% non-Hispanic white, 38% non-Hispanic Black, 20% Hispanic, 62% <$25K income. High DD (DDS ≥2) was reported by 108 (23.6%). Subscales found 39.8% with high "regimen distress," 29.8% with high "emotional burden" (29.8%). Unadjusted results: Sex (p=0.001), HbA1c (p<0.0001), no healthcare coverage (p=0.043), hypertension (p=0.036) and retinopathy (p=0.005) were associated with DD. Moderate-severe depressive symptoms (PHQ-9 ≥10) and anxiety (GAD≥5) were also associated with DD (p<0.0001). In multivariate analyses, female sex, anxiety, HbA1c (p<0.0001 for all), and no healthcare coverage (p=0.022) remained associated with DD. Individual microvascular complications, BMI, depressive symptoms, race/ethnicity, age, education, income, # persons in household, or having a diabetes care provider did not relate to adjusted DD. Conclusion: In young adults with youth-onset T2D, high DD was significantly more likely in females, and those with anxiety, high HbA1c, and without healthcare coverage.