Brigida A Bruno1, Dorothy Choi2, Kevin E Thorpe3, Catherine H Yu4,5. 1. Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 2. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. 3. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 4. Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada yuca@smh.ca. 5. Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: The primary outcome is to evaluate the relationship between diabetes distress and decisional conflict regarding diabetes care in patients with diabetes and two or more comorbidities. Secondary outcomes include the relationships between diabetes distress and quality of life and patient perception of chronic illness care and decisional conflict. RESEARCH DESIGN AND METHODS: This was a cross-sectional study of 192 patients, ≥18 years of age, with type 2 diabetes and two or more comorbidities, recruited from primary care practices in the Greater Toronto Area. Baseline questionnaires were completed using validated scales: Diabetes Distress Scale (DDS), Decisional Conflict Scale (DCS), Short-Form Survey 12 (SF-12), and Patient Assessment of Chronic Illness Care (PACIC). Multiple linear regression models evaluated associations between summary scores and subscores, adjusting for age, education, income, employment, duration of diabetes, and social support. RESULTS: Most participants were >65 years old (65%). DCS was significantly and positively associated with DDS (β = 0.0139; CI 0.00374-0.0246; P = 0.00780). DDS-emotional burden subscore was significantly and negatively associated with SF-12-mental subscore (β =-3.34; CI -4.91 to -1.77; P < 0.0001). Lastly, DCS was significantly and negatively associated with PACIC (β = -6.70; CI -9.10 to -4.32; P < 0.0001). CONCLUSIONS: We identified a new positive relationship between diabetes distress and decisional conflict. Moreover, we identified negative associations between emotional burden and mental quality of life and patient perception of chronic illness care and decisional conflict. Understanding these associations will provide valuable insights in the development of targeted interventions to improve quality of life in patients with diabetes.
OBJECTIVE: The primary outcome is to evaluate the relationship between diabetes distress and decisional conflict regarding diabetes care in patients with diabetes and two or more comorbidities. Secondary outcomes include the relationships between diabetes distress and quality of life and patient perception of chronic illness care and decisional conflict. RESEARCH DESIGN AND METHODS: This was a cross-sectional study of 192 patients, ≥18 years of age, with type 2 diabetes and two or more comorbidities, recruited from primary care practices in the Greater Toronto Area. Baseline questionnaires were completed using validated scales: Diabetes Distress Scale (DDS), Decisional Conflict Scale (DCS), Short-Form Survey 12 (SF-12), and Patient Assessment of Chronic Illness Care (PACIC). Multiple linear regression models evaluated associations between summary scores and subscores, adjusting for age, education, income, employment, duration of diabetes, and social support. RESULTS: Most participants were >65 years old (65%). DCS was significantly and positively associated with DDS (β = 0.0139; CI 0.00374-0.0246; P = 0.00780). DDS-emotional burden subscore was significantly and negatively associated with SF-12-mental subscore (β =-3.34; CI -4.91 to -1.77; P < 0.0001). Lastly, DCS was significantly and negatively associated with PACIC (β = -6.70; CI -9.10 to -4.32; P < 0.0001). CONCLUSIONS: We identified a new positive relationship between diabetes distress and decisional conflict. Moreover, we identified negative associations between emotional burden and mental quality of life and patient perception of chronic illness care and decisional conflict. Understanding these associations will provide valuable insights in the development of targeted interventions to improve quality of life in patients with diabetes.
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