Cross-sectional and longitudinal analysis of the association between diabetes distress and sociodemographic, lifestyle and diabetes related factors in a sample of adults with type 2 diabetes
Bibliographic record
Abstract
INTRODUCTION.Moderate to severe diabetes distress (DD) is a common mental health comorbidity among adults with type 2 diabetes and is characterized by negative emotions, worries and fears relating to living with diabetes and its management. Cross-sectional studies find DD is strongly and independently correlated with poorer diabetes health and disease management however, few studies have examined how lifestyle behaviors such as smoking, physical activity and alcohol consumption relate to DD. Additionally, the vast majority of the published literature on DD has been cross-sectional, and relatively little is known about the pattern of change of DD symptoms over long periods of time. The objectives of the following thesis are two-fold: 1) to examine the association between moderate and severe DD and lifestyle behaviors (physical activity, smoking, alcohol consumption) according to gender, 2) to identify and describe longitudinal changes in DD symptoms over 4 years of follow-up time. GENERAL METHODS. The data for this thesis were derived from the Evaluation of Diabetes Treatment study, a longitudinal community based survey of Canadian adults with type 2 diabetes (2011-2014). Participants were recruited using mixed methods sampling and were considered eligible if they had a doctor diagnosis of type 2 diabetes (≤10 years), were insulin-naïve, between 40 and 75 years of age and from Quebec, Canada. A total of 2,028 adults completed the baseline interview and provided information on DD, lifestyle behaviors, mental health, sociodemographic and diabetes related factors. RESULTS. Cross-sectional analyses: A series of multinomial logistic regression analyses were used to evaluate the association between DD and lifestyle behaviors. Effects estimates can be interpreted as probability ratios (PR). In females, physical inactivity was associated with an increased likelihood of moderate distress (PR: 2.2 (1.49-3.24)) and severe distress (PR: 1.80 (1.00-3.24)). In males, only severe distress was associated with physical inactivity (PR: 1.92 (1.00-3.66)). Current smoking was associated with a greater probability of severe distress in both males and females; however this effect was stronger in male smokers (PR: 3.0 (1.54-5.84)) than female smokers (PR: 1.32 (0.67-2.60)). No association was found between alcohol consumption and DD in females, however, in males, frequent alcohol consumption was associated with a reduced probability of moderate (PR: 0.56 (0.34-0.91)) and severe distress (PR: 0.47 (0.21-1.06)). Longitudinal analyses: We used a latent class group modelling approach to uncover trajectories of DD over 4 years of follow up time. Five distinct trajectories of DD were identified. Trajectories 1 and 2 described participants with persistently low distress (61% of sample) or persistently low, but at risk levels of distress (22% of sample). Trajectory 3 (7.5% of sample) included participants with moderate levels of distress that decreased over time. Trajectories 4 (6.5% of sample) and 5 (2.4% of sample) consisted of participants with moderate, but increasing levels of distress and persistently high (severe) levels of distress, respectively. Additionally, participants following trajectories of moderate and severe distress tended to have worse baseline mental and physical health.CONCLUSIONS.The findings from this thesis suggest an important role for DD in diabetes-related health behaviors and diabetes disease management. Additionally, the results indicate that for a subset of individuals, DD is a persistent condition over 4 years of follow-up time, while for other patients; DD symptoms may worsen over time. The dynamic nature of DD suggests that individuals may differ in their risk of developing negative health outcomes, and interventions aimed at reducing DD levels may not be warranted for all patients with DD symptoms. Screening for DD in high-risk patient groups may be an important consideration for medical health professionals.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".