Determinants of Stress and Obstacles to Diabetes‐Related Quality of Life in Adults With Type 2 Diabetes: A Cross‐Sectional Interaction–Mediation Analysis

BACKGROUND: Diabetes-related quality of life (DR-QoL) is shaped by interactions between cardiometabolic dysfunction and psychological stress, yet these mechanisms are rarely examined within a unified framework. AIMS: To evaluate the independent, interactive, and mediating effects of cardiometabolic factors and stress on DR-QoL obstacles. METHODS: A cross-sectional study was conducted among 1815 adults with type 2 diabetes from 15 Indonesian provinces (2023-2024). Stress and DR-QoL obstacles were assessed using validated instruments. Independent and synergistic effects were examined using logistic regression, and mediation was tested via path analysis. RESULTS: Overweight, obesity, stage 2 systolic hypertension, and abnormal fasting blood glucose (FBG) significantly predicted high stress (AOR = 1.982-20.889; p < 0.001), with synergistic interactions markedly amplifying the risk (AOR up to 53.972). DR-QoL obstacles were strongly associated with cardiometabolic abnormalities (AOR = 1.352-18.420) and high stress (AOR = 18.930), with the highest risk observed in participants with multiple concurrent abnormalities (AOR = 52.097). Mediation analysis identified FBG and stress as key mediators, with stress showing the strongest direct effect on DR-QoL obstacles (β = 0.397). LINKING EVIDENCE TO ACTION: These findings highlight FBG and stress as central mechanistic targets for interventions aimed at reducing DR-QoL obstacles.