The Moderating Role of Social Support in the Association between Diabetes Distress and Health-Related Quality of Life in Rural Adults with Type 2 Diabetes

Introduction: West Virginia, a rural and entirely Appalachian state, has the highest prevalence of diabetes in the U.S., which is associated with higher diabetes distress and lower health-related quality of life (HRQoL). Yet, few studies have explored the nuanced role of social support as a buffer against distress, that is pivotal in designing effective interventions. Therefore, this study explored the moderating effect of social support between diabetes distress (total and its four domains) and HRQoL among individuals with type 2 diabetes mellitus (T2DM) in West Virginia. Methods: This statewide cross-sectional study of T2DM individuals was conducted during the COVID-19 pandemic (September 2021- December 2022) using an online REDCap survey. Participants completed socio-demographic characteristics (age, gender, race, educational status, income, and rural residence) along with the Diabetes Distress Scale (DDS-17), the Patient-Reported Outcome Measurement Information System (PROMIS-10) and a single-item measure of social support. Linear regression analyses estimated the association between HRQoL (outcome variable), diabetes distress (exposure variable) and its four domains (regimen-related, physician-related, interpersonal, and emotional burden) and interaction of social support and diabetes distress, adjusting for age, gender, race, education, income, diabetes duration and rural residence. Results: A total of 1,026 participants (mean age=58.40 ± 12.54; 63.20% female) were included in the analysis. About half of the participants resided in rural areas and had low socio-economic status (i.e., 25% reported an annual income below $25,000 and 19% had a college degree). Participants had lower mean T-scores for global physical health (40.70 ± 9.20) and global mental health (41.50 ± 10.10) compared to the general U.S. population. Most participants (92.90%) reported having social support and low to moderate diabetes distress. Multivariate analysis revealed a significant moderating effect of physician-related distress on global mental health with social support having a protective role that buffered the negative impact of physician-related distress on global mental health. Conclusion: Findings indicated that HRQoL was lower than the US population average among individuals with T2DM in West Virginia. Additionally, social support ameliorated the negative effects of physician-related distress on global mental health highlighting its protective role.