Diabetes distress and its correlation with glycemic control among type 2 diabetes patients at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Type 2 Diabetes Mellitus (T2DM) presents not only a complex metabolic disorder but also imposes a substantial psychological burden in the form of diabetes distress, a condition characterized by negative emotional responses to the ongoing demands of diabetes self-management. This condition continues to emerge as a critical barrier to optimal disease control with growing evidence linking it to poor self-care behaviors, suboptimal glycemic outcomes and increased risk of complications. Despite its clinical relevance, the prevalence of diabetes distress, its associated determinants and impact on glycemic control remain underexplored in many low- and middle-income settings including Kenya. Objectives: This study aimed to determine the prevalence of diabetes distress among individuals with T2DM, assess their level of glycemic control and evaluate whether diabetes distress independently predicts poor glycemic control. Methods: A hospital-based cross-sectional study was conducted among 354 adult patients with T2DM at Moi Teaching and Referral Hospital from January 2024 to December 2024. Data on demographic, socioeconomic and clinical characteristics were collected using structured questionnaires. Diabetes distress was assessed using the validated 17-item Diabetes Distress Scale (DDS-17) while glycemic control was evaluated using glycated hemoglobin (HbA1c). Statistical analyses using descriptive statistics, Chi-square and t-tests for bivariate associations, and multivariable logistic regression, was done to assess the correlation between Diabetes distress and glycemic control. Results: The study population was predominantly female (65.3%), unemployed (67.8%), and uninsured (63.0%), with a mean age of 56.3 years. Over half (52.8%) had coexisting hypertension. The overall prevalence of diabetes distress was 15.8%, with emotional burden (50.3%) and regimen-related distress (33.1%) emerging as the most prominent subdomains. Significant associations were observed between diabetes distress and treatment modality (p < 0.001), especially combination therapy, and comorbid hypertension (p = 0.014). The mean HbA1c was 9.34%, with 57.4% of participants exhibiting poor or very poor glycemic control (HbA1c ≥ 8%). Poor glycemic control was significantly associated with treatment type(insulin) (p < 0.001) and occupational status(unemployed) (p = 0.021). Importantly, multivariable logistic regression revealed that diabetes distress independently predicted poor glycemic control (AOR = 2.31; 95% CI: 1.16–4.62; p = 0.017), indicating that distressed individuals were over twice as likely to have inadequate glycemic control. Conclusion: Diabetes distress is prevalent among patients with T2DM, with a high proportion also demonstrating poor glycemic control. Diabetes distress was independently associated with poor glycemic outcomes, with affected individuals being more than twice as likely to have inadequate control. Emotional and regimen-related distress emerged as the predominant contributors, highlighting the substantial psychological burden in this population. These findings highlight the necessity of addressing psychological distress as an integral component of diabetes care. Recommendations: Assessment of diabetes distress should be incorporated into routine diabetes care, particularly for patients with poor glycemic control, given its association with adverse outcomes. Additionally, further research is needed to explore practical and effective strategies for screening and managing diabetes distress within the Kenyan healthcare setting.