August 21, 2020
2 min read
Young CF. Exploring Relationships between Diabetes-Related Distress and Predicted Cardiovascular Risks in Patients with Type 2 Diabetes. Presented at: Association of Diabetes Care & Education Specialists Annual Meeting; Aug. 13-16, 2020 (virtual meeting).
Young reports no relevant financial disclosures.
Adults with type 2 diabetes who experience stress connected with their disease may be at higher risk for fatal coronary heart disease, according to a speaker.
“This is not always the priority,” Clipper F. Young, PharmD, MPH, CDE, BC-ADM, BCGP, associate professor and clinical pharmacist at Touro University California College of Osteopathic Medicine, told Healio. “We have been trained as clinicians to focus on all of the clinical aspects [of diabetes], but we need to do more and focus on the psychosocial aspects.”
Young and colleagues recruited 234 adults (122 women) with type 2 diabetes aged 40 to 85 years who were prescribed at least one diabetes medication and who had at least one visit to a Solano County Family Health Services clinic. Each participant provided responses to 20 common diabetes issues, on a Likert scale of 0 to 4, on the Problem Areas in Diabetes (PAID) questionnaire. Higher scores indicated more serious problems. Socioeconomic status was also factored in, with a score given to each participant based on their occupation on a scale of 1 to 100. Jobs such as dentist and physician were scored highest, whereas professions such as dishwasher were scored lowest.
Participants had duration of diabetes, HbA1c, systolic blood pressure, total cholesterol and HDL cholesterol placed into the U.K. Prospective Diabetes Study (UKPDS) Risk Engine. Demographic information such as age, sex, ethnicity and smoking status was also collected.
Clipper F. Young
The study looked at four outcomes: CHD, fatal CHD, stroke and fatal stroke, and compared those risks with each participant’s PAID score. Three linear regression models were created, with each controlling for different confounding factors. The first model controlled for depression, the second model factored in systolic BP and the third model controlled for BMI. All three models had tobacco use, LDL levels, sex and age as covariables.
Associations between predicted fatal CHD risks and the participant’s PAID score were found in model one (P = .014), model two (P = .029) and model three (P = .032). An association was found between CHD risks and the PAID score in model one (P = .039), but not in models two and three. There were no associations found between the PAID score and predicted stroke and fatal stroke risks.
“Diabetes-related stress has shown to be significantly associated with the 10-year fatal CHD risk in all three models,” Young said. “That means we want to identify diabetes-related stress early on so we can implement any intervention if needed.”
The American Diabetes Association recommends that providers assess diabetes distress periodically and whenever there is a change in the disease.
“I understand that it is very difficult to add another thing if [providers] only have 15 minutes of time with their patient,” Young said. “If they think they have done a lot of adjustments to their patient’s medication regimen, but don’t see any changes in terms of their HbA1c outcome or their sugar readings, or their patients are not willing to check their sugar, the next step is getting into the psychological aspect of management.”