Diabetes-related distress in a multiethnic primary care population with type 2 diabetes mellitus in Singapore: magnitude and associated risk factors

Abstract Introduction: We determined the magnitude and associated risk factors of diabetes-related distress (DRD) in patients with type 2 diabetes mellitus (T2DM) attending primary care clinics. Methods: In this cross-sectional clinic-based study, Singaporean patients with T2DM attending DM complications screening at six polyclinics were recruited. Relevant data were obtained from medical records and questionnaires. ‘Possible’ DRD was indicated by a score of ≥8 on the five-item Problem Areas in Diabetes questionnaire. Multivariable logistic regression was used to examine the sociodemographic, medical, clinical and patient-reported factors associated with possible DRD. Results: Among the 970 participants (median [interquartile range] age 61.0 [55–67] years; 47.1% female, 64.1% Chinese), 171 (17.6%) and 799 (82.3%) had possible DRD and no DRD, respectively. Every 1-year increase in age was associated with a 4% reduction in the odds of having possible DRD (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.94–0.98; P <0.001). Malays had nearly three times the odds of possible DRD compared to Chinese patients. Those with arthritis and any DM complication had two-fold odds of possible DRD. Furthermore, ‘fair/poor’ self-rated health status and ‘poor’ self-rated DM control were independently associated with possible DRD ( P <0.05). Conversely, participants who currently consumed alcohol (OR: 0.50, 95% CI: 0.28–0.89; P = 0.019) and those with better health literacy (OR: 0.81, 95% CI: 0.75–0.88; P <0.001) had lower odds of possible DRD. Conclusion: Nearly one in five patients with T2DM had possible DRD in our primary care population. Interventions focusing on improving modifiable factors, together with integration of psychological care, may reduce the levels of DRD in this population.