Relationship between diabetes-related distress and control of diabetes in type 2 diabetes patients in primary care units in Phra Nakhon Si Ayutthaya
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20260756Keywords:
Type 2 diabetes mellitus, Diabetes-related distress, Glycemic controlAbstract
Background: This study aimed to study the association between diabetes-related distress (DRD) and glycemic control, as well as to identify factors influencing glycemic controlled among patients with type 2 diabetes mellitus (T2DM) attending a primary care unit in Phra Nakhon Si Ayutthaya Province.
Methods: Data were collected from 60 patients with type 2 diabetes at a primary care facility in Phra Nakhon Si Ayutthaya from December of 2024 to May of 2025. Multivariable logistic regression analysis was used to evaluate the relationships between the variables.
Results: The study found that total 60 participants, 33 achieved good glycemic control, while 27 had uncontrolled levels. The analysis revealed no statistically significant association between diabetes-related distress and glycemic control (multivariable marginal OR 2.40; 95% CI: 0.36–16.21; p value=0.368). However, factors significantly associated with uncontrolled glycemic levels included age under 65 years (multivariable marginal OR 2.88; 95% CI: 1.04–7.97; p value=0.041) and a duration of diabetes exceeding 10 years (multivariable marginal OR 5.88; 95% CI: 1.93–17.93; p value=0.002).
Conclusions: This study found no significant association between diabetes-related distress and glycemic control. However, two factors were significantly linked to uncontrolled blood sugar levels: being under 65 years old and having diabetes for more than 10 years.
Metrics
References
International Diabetes Federation. IDF Diabetes Atlas. 10th edition. Brussels: International Diabetes Federation; 2021.
Division of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health (TH). Number and mortality rate of 5 major non-communicable diseases. 2024. Available at: https://www.ddc.moph.go.th/dncd/news.php?news=39911. Accessed on 12 January 2026.
Risk Communication and Health Behavior Development Bureau, Department of Disease Control, Ministry of Public Health (TH). DDC campaigns for World Diabetes Day 2023: emphasizing public education on diabetes risks and early detection to mitigate severe complications. 2023. Available at: https://ddc.moph.go.th/brc/news. php?news=38403&deptcode=brc&news_views=2606#m148. Accessed on 12 January 2026.
American Diabetes Association. Standards of Care in Diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S1-S285. DOI: https://doi.org/10.2337/dc24-SDIS
Diabetes Association of Thailand, Endocrine Society of Thailand. Clinical Practice Guideline for Diabetes 2023. Bangkok: Sri Muang Printing. 2023.
Farmaki P, Damaskos C, Garmpis N, Garmpi A, Savvanis S, Diamantis E. Complications of the Type 2 Diabetes Mellitus. Curr Cardiol Rev. 2020;16(4):249-51. DOI: https://doi.org/10.2174/1573403X1604201229115531
Haghighatpanah M, Nejad ASM, Haghighatpanah M, Thunga G, Mallayasamy S. Factors that Correlate with Poor Glycemic Control in Type 2 Diabetes Mellitus Patients with Complications. Osong Public Health Res Perspect. 2018;9(4):167-74. DOI: https://doi.org/10.24171/j.phrp.2018.9.4.05
Tunsuchart K, Lerttrakarnnon P, Srithanaviboonchai K, Likhitsathian S, Skulphan S. Type 2 Diabetes Mellitus Related Distress in Thailand. Int J Environ Res Public Health. 2020;17(7):2329. DOI: https://doi.org/10.3390/ijerph17072329
Ruangchaisiwawet A, Bankhum N, Tanasombatkul K, Phinyo P, Yingchankul N. Prevalence and the association between clinical factors and Diabetes-Related Distress (DRD) with poor glycemic control in patients with type 2 diabetes: A Northern Thai cross-sectional study. PLoS One. 2023;18(11):e0294810. DOI: https://doi.org/10.1371/journal.pone.0294810
Thanakwang K, Thinganjana W, Konggumnerd R. Psychometric properties of the Thai version of the Diabetes Distress Scale in diabetic seniors. Clin Interv Aging. 2014;9:1353-61. DOI: https://doi.org/10.2147/CIA.S67200
Fisher L, Gonzalez JS, Polonsky WH. The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision. Diabet Med. 2014;31(7):764-72. DOI: https://doi.org/10.1111/dme.12428
Diabetes UK. Chapter 3 - diabetes distress. Available at: https://www.diabetes.org.uk/for-professionals/ improving-care/good-practice/psychological-care/emotional-health-professionals-guide/chapter-3-diabetes-distress. Accessed on 12 January 2026.
Wong EM, Afshar R, Qian H, Zhang M, Elliott TG, Tang TS. Diabetes Distress, Depression and Glycemic Control in a Canadian-Based Specialty Care Setting. Can J Diabetes. 2017;41(4):362-5. DOI: https://doi.org/10.1016/j.jcjd.2016.11.006
Batais MA, Alfraiji AF, Alyahya AA, Aloofi OA, Almashouq MK, Alshehri KS, et al. Assessing the Prevalence of Diabetes Distress and Determining Its Psychosocial Predictors Among Saudi Adults With Type 2 Diabetes: A Cross-Sectional Study. Front Psychol. 2021;12:785231. DOI: https://doi.org/10.3389/fpsyg.2021.759454
Xu C, Zhang Y, Li Y, Liu QZ, Wu HX, Xu ZJ, et al. Comparative study of the influence of diabetes distress and depression on treatment adherence in Chinese patients with type 2 diabetes: a cross-sectional survey in the People's Republic of China. Neuropsychiatr Dis Treat. 2013;9:1289-307. DOI: https://doi.org/10.2147/NDT.S49798
Bhaskara G, Budhiarta AAG, Gotera W, Saraswati MR, Dwipayana IMP, Semadi IMS, et al. Factors Associated with Diabetes-Related Distress in Type 2 Diabetes Mellitus Patients. Diabetes Metab Syndr Obes. 2022;15:2077-85. DOI: https://doi.org/10.2147/DMSO.S363431
Rosner B. Fundamentals of Biostatistics. 5th edition. Pacific Grove, CA: Duxbury / Thomson Learning; 2000.
Mirghani HO. Diabetes distress, the mediator of the poor glycemic control and depression: A meta-analysis. World J Metaanal. 2024;12(4):5779. DOI: https://doi.org/10.13105/wjma.v12.i4.97779
Bazelmans E, Netea-Maier RT, Vercoulen JH, Tack CJ. Surprisingly few psychological problems and diabetes-related distress in patients with poor glycaemic control. Neth J Med. 2016;74(1):16-21.
Güemes M, Rahman SA, Hussain K. What is a normal blood glucose? Arch Dis Child. 2016;101(6):569-74. DOI: https://doi.org/10.1136/archdischild-2015-308336
Wibowo ZK, Mudjanarko SW, Khairina K. The relationship between diabetes distress and HbA1C level in type 2 diabetes mellitus therapy patients: a systematic review. Bali Med J. 2022;11(1):476-84. DOI: https://doi.org/10.15562/bmj.v11i1.2986
Cherrington AL, Bebu I, Krause-Steinrauf H, Hoogendoorn CJ, Crespo-Ramos G, Presley C, et al. Does Emotional Distress Predict Worse Glycemic Control Over Time? Results From the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care. 2024;47(4):620-8. DOI: https://doi.org/10.2337/figshare.24294964.v1
Nathan DM, Buse JB, Kahn SE, Krause-Steinrauf H, Larkin ME, Staten M, et al. Rationale and Design of the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care. 2013;36(8):2254-61. DOI: https://doi.org/10.2337/dc13-0356
Zhang H, Zhang Q, Luo D, Cai X, Li R, Zhang Y, et al. The effect of family-based intervention for adults with diabetes on HbA1c and other health-related outcomes: Systematic review and meta-analysis. J Clin Nurs. 2022;31(11-12):1488-501. DOI: https://doi.org/10.1111/jocn.16082
Riise HKR, Haugstvedt A, Igland J, Graue M, Søfteland E, Hermann M, et al. Diabetes distress and associated psychosocial factors in type 2 diabetes. A population-based cross-sectional study. The HUNT study, Norway. Diabetol Metab Syndr. 2025;17(1):62. DOI: https://doi.org/10.1186/s13098-025-01631-w
Chew BH, Vos R, Mohd-Sidik S, Rutten GEHM. Diabetes-Related Distress, Depression and Distress-Depression among Adults with Type 2 Diabetes Mellitus in Malaysia. PLoS One. 2016;11(3):e0152095. DOI: https://doi.org/10.1371/journal.pone.0152095
Phuwilert P, Khiewkhern S, Phajan T, Wongprachum K, Wibuloutai J, Srichomphoo C, et al. Factors Affecting Glycemic Control in Patients with Type 2 Diabetes in Kalasin Province, Thailand: An Analytical Cross-Sectional Study. Healthcare. 2024;12(19):1916. DOI: https://doi.org/10.3390/healthcare12191916
Selvin E, Parrinello CM. Age-related differences in glycaemic control in diabetes. Diabetologia. 2013;56(12):2549-51. DOI: https://doi.org/10.1007/s00125-013-3078-7
Rajbhandari B, Hyoju SP, Poudel L, Adhikari A, Rijal B, Joshi P. Prevalence of Type 2 Diabetes among Patients Visiting Nepal Police Hospital in Kathmandu: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2021;59(233):42-5. DOI: https://doi.org/10.31729/jnma.5734
Barrot-de la Puente J, Mata-Cases M, Franch-Nadal J, Mundet-Tudurí X, Casellas A, Fernandez-Real JM, et al. Older type 2 diabetic patients are more likely to achieve glycaemic and cardiovascular risk factors targets than younger patients: analysis of a primary care database. Int J Clin Pract. 2015;69(12):1486-95. DOI: https://doi.org/10.1111/ijcp.12741
Azagew AW, Mekonnen CK, Lambie M, Shepherd T, Babatunde OO. Poor glycemic control and its predictors among people living with diabetes in low- and middle-income countries: a systematic review and meta-analysis. BMC Public Health. 2025;25(1):714. DOI: https://doi.org/10.1186/s12889-025-21828-y
Bitew ZW, Alemu A, Jember DA, Tadesse E, Getaneh FB, Seid A, et al. Prevalence of Glycemic Control and Factors Associated With Poor Glycemic Control: A Systematic Review and Meta-analysis. Inquiry. 2023;60:469580231152145. DOI: https://doi.org/10.1177/00469580231155716