The association between Problem Areas in Diabetes Scale scores and glycemic control is modified by types of diabetes therapy: Diabetes Distress and Care Registry in Tenri (DDCRT 2)

Abstract

Aim

To evaluate the joint association of Problem Areas in Diabetes (PAID) Scale scores and glycemic control with diabetes therapy.

Methods

We used 3479 patients’ data with type 1 and type 2. Modified Poisson regression analysis was used to estimate relative risks (RRs) for poor glycemic control (HbA1c ≥ 7.0%) across quartiles of PAID scores.

Results

Compared with the 1st quartile of PAID score, multivariable-adjusted RRs for poor glycemic control were 0.99 (95%CI, 0.87–1.11), 1.05 (95%CI, 0.93–1.18), and 1.12 (95%CI, 1.00–1.27), respectively, for 2nd to 4th quartiles, and we observed significant trend (p for trend = 0.03). We observed significant interaction of PAID score and HbA1c with diabetes therapy (p = 0.0469). In patients receiving diet only therapy, the RRs for poor glycemic control were 1.38 (95%CI, 0.93–2.05), 1.18 (95%CI, 0.51–5.13), and 1.81 (95%CI, 1.16–2.79), respectively for 2nd to 4th quartiles of PAID score compared with the 1st quartile (p for trend = 0.025); while we did not observe significant association between PAID and poor glycemic control in patients receiving medication therapy.

Conclusions

Diabetes distress measured by PAID survey was associated with poor glycemic control, and this association was modified by diabetes therapy.

Introduction

Diabetes is a chronic medical illness that requires careful adherence to a daily treatment that can be complex and demanding. For patients with diabetes, treatment can have a significant impact on many aspects of quality of life. However, the association between glycemic control and patient-reported outcomes (both generic and diabetes-specific) is complex and little research has been done in this area. Diabetes-related emotional distress is an important element of diabetes quality of life that may influence adherence to self-care, glycemic control. Polonsky et al. developed the Problem Areas in Diabetes (PAID) Scale to measure emotional distress in patients with diabetes, and they revealed that PAID scores vary by such as treatment modality, and correlate with glycemic control in patients with diabetes [1]. Despite considerable research in this specific field, previous researches have not yet addressed if the magnitude of association between PAID scores and glycemic control may vary by patients’ characteristics or treatment modality. Especially, our hypothesis is that the association between PAID scores may vary by treatment modality: diabetes related distress plays a more important role in diabetes care of patients without medication therapy than those with, because diabetes related distress is associated with poor adherence to diabetes related self-care [2], and the magnitude of influence of self-care towards diet and exercise on glycemic control might vary depending on the type of therapy (diet therapy, oral medication or insulin). Evaluating our hypothesis will provide deeper insight into the relationship between glycemic control and patient-reported outcomes.

Primary objective of this study is to evaluate the joint association of PAID scores and glycemic control with diabetes therapy using a large, single-center registry of patients with diabetes. Secondarily, we evaluated the joint association with other patients’ characteristics.