Diabetes distress in Veterans with type 2 diabetes mellitus: Qualitative descriptive study

doi:10.1177/13591053241233387

Observational Study

. 2024 Dec;29(14):1593-1607.

doi: 10.1177/13591053241233387. Epub 2024 Feb 21.

Diabetes distress in Veterans with type 2 diabetes mellitus: Qualitative descriptive study

Allison A Lewinski^{1

2}, Abigail Shapiro¹, Matthew J Crowley^{1

3}, Chelsea Whitfield¹, Joanne Roman Jones^{1

4}, Amy S Jeffreys¹, Cynthia J Coffman^{1

5}, Teresa Howard¹, Eleanor McConnell^{1

6}, Paula Tanabe^{2

7}, Susan Barcinas⁸, Hayden B Bosworth^{1

2

9

10

11}

Affiliations

¹ Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA.
² Duke University School of Nursing, Durham, NC, USA.
³ Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
⁴ Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA.
⁵ Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
⁶ Geriatric Research, Education and Clinical Center (GRECC), Durham Veterans Affairs Health Care System, Durham, NC, USA.
⁷ Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
⁸ College of Education, North Carolina State University, Raleigh, NC, USA.
⁹ Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA.
¹⁰ Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
¹¹ Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.

PMID: 38384142
PMCID: PMC11491149 (available on 2025-12-01)
DOI: 10.1177/13591053241233387

Observational Study

Diabetes distress in Veterans with type 2 diabetes mellitus: Qualitative descriptive study

Allison A Lewinski et al. J Health Psychol. 2024 Dec.

. 2024 Dec;29(14):1593-1607.

doi: 10.1177/13591053241233387. Epub 2024 Feb 21.

Authors

Affiliations

¹ Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA.
² Duke University School of Nursing, Durham, NC, USA.
³ Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
⁴ Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA.
⁵ Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
⁶ Geriatric Research, Education and Clinical Center (GRECC), Durham Veterans Affairs Health Care System, Durham, NC, USA.
⁷ Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
⁸ College of Education, North Carolina State University, Raleigh, NC, USA.
⁹ Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA.
¹⁰ Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
¹¹ Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.

PMID: 38384142
PMCID: PMC11491149 (available on 2025-12-01)
DOI: 10.1177/13591053241233387

Abstract

Diabetes distress (DD) is a negative psychosocial response to living with type 2 diabetes mellitus (T2DM). We sought insight into Veterans' experiences with DD in the context of T2DM self-management. The four domains in the Diabetes Distress Scale (i.e. regimen, emotional, interpersonal, healthcare provider) informed the interview guide and analysis (structural coding using thematic analysis). The mean age of the cohort (n = 36) was 59.1 years (SD 10.4); 8.3% of patients were female and 63.9% were Black or Mixed Race; mean A1C was 8.8% (SD 2.0); and mean DDS score was 2.4 (SD 1.1), indicating moderate distress. Veterans described DD and challenges to T2DM self-management across the four domains in the Diabetes Distress Scale. We found that (1) Veterans' challenges with their T2DM self-management routines influenced DD and (2) Veterans experienced DD across a wide range of domains, indicating that clinical interventions should take a "whole-person" approach.Trial Registration: NCT04587336.

Keywords: Diabetes mellitus; Veterans; qualitative research; self-management; type 2.

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Conflict of interest statement

Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Bosworth reports research funding through his institution from BeBetter Therapeutics, Boehringer Ingelheim, Esperion, Improved Patient Outcomes, Merck, NHLBI, Novo Nordisk, Otsuka, Sanofi, VA. Elton John Foundation, Hilton foundation, Pfizer. He also provides consulting services for Abbott, Esperion, Imatar, Novartis, Sanofi, Vidya, Walmart, WebMD. He was also on the board of directors of Preventric Diagnostics. Dr. Lewinski reports receiving funds from PhRMA Foundation and Otsuka for activities not related to this work. The remaining authors have no competing interests to declare.

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Evaluating the Impact of Individualized Interventions on Diabetes Distress and Glycemic Outcomes: A Shift From Glycated Hemoglobin (HbA1c) to Random Blood Sugar (RBS) in a Quasi-experimental Study.
Swathi NL, P VP, M D, Mohammed AP, D J, Umar M, Muhammad Ali S, Iqbal J, P P. Swathi NL, et al. Cureus. 2025 Mar 20;17(3):e80890. doi: 10.7759/cureus.80890. eCollection 2025 Mar. Cureus. 2025. PMID: 40255758 Free PMC article.

References

1. Adriaanse MC, Pouwer F, Dekker JM, et al. (2008) Diabetes-related symptom distress in association with glucose metabolism and comorbidity: the Hoorn Study. Diabetes Care 31(12): 2268–2270. - PMC - PubMed
1. Ahola AJ and Groop PH (2013) Barriers to self-management of diabetes. Diabet Med 30(4): 413–420. - PubMed
1. Aikens JE, Zivin K, Trivedi R and Piette JD (2014) Diabetes self-management support using mHealth and enhanced informal caregiving. J Diabetes Complications 28(2): 171–176. - PMC - PubMed
1. Arifin B, Probandari A, Purba AKR, et al. (2020) ‘Diabetes is a gift from god’ a qualitative study coping with diabetes distress by Indonesian outpatients. Quality of Life Research 29(1): 109–125. - PMC - PubMed
1. Berry E, Davies M and Dempster M (2020) Exploring the perceptions of emotional distress among couples living with Type 2 diabetes and among diabetes healthcare providers, and consideration of support needs. Diabetic Medicine 37(10): 1669–1678. - PubMed

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[1] Adriaanse MC, Pouwer F, Dekker JM, et al. (2008) Diabetes-related symptom distress in association with glucose metabolism and comorbidity: the Hoorn Study. Diabetes Care 31(12): 2268–2270. - PMC - PubMed

[2] Adriaanse MC, Pouwer F, Dekker JM, et al. (2008) Diabetes-related symptom distress in association with glucose metabolism and comorbidity: the Hoorn Study. Diabetes Care 31(12): 2268–2270. - PMC - PubMed

[3] Ahola AJ and Groop PH (2013) Barriers to self-management of diabetes. Diabet Med 30(4): 413–420. - PubMed

[4] Ahola AJ and Groop PH (2013) Barriers to self-management of diabetes. Diabet Med 30(4): 413–420. - PubMed

[5] Aikens JE, Zivin K, Trivedi R and Piette JD (2014) Diabetes self-management support using mHealth and enhanced informal caregiving. J Diabetes Complications 28(2): 171–176. - PMC - PubMed

[6] Aikens JE, Zivin K, Trivedi R and Piette JD (2014) Diabetes self-management support using mHealth and enhanced informal caregiving. J Diabetes Complications 28(2): 171–176. - PMC - PubMed

[7] Arifin B, Probandari A, Purba AKR, et al. (2020) ‘Diabetes is a gift from god’ a qualitative study coping with diabetes distress by Indonesian outpatients. Quality of Life Research 29(1): 109–125. - PMC - PubMed

[8] Arifin B, Probandari A, Purba AKR, et al. (2020) ‘Diabetes is a gift from god’ a qualitative study coping with diabetes distress by Indonesian outpatients. Quality of Life Research 29(1): 109–125. - PMC - PubMed

[9] Berry E, Davies M and Dempster M (2020) Exploring the perceptions of emotional distress among couples living with Type 2 diabetes and among diabetes healthcare providers, and consideration of support needs. Diabetic Medicine 37(10): 1669–1678. - PubMed

[10] Berry E, Davies M and Dempster M (2020) Exploring the perceptions of emotional distress among couples living with Type 2 diabetes and among diabetes healthcare providers, and consideration of support needs. Diabetic Medicine 37(10): 1669–1678. - PubMed

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Diabetes distress in Veterans with type 2 diabetes mellitus: Qualitative descriptive study

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Diabetes distress in Veterans with type 2 diabetes mellitus: Qualitative descriptive study

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Conflict of interest statement

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