Type 2 diabetes mellitus is a chronic and progressive disease that has reached the epidemic level around the world. In Malaysia, according to the third National Health and Morbidity Survey (2006), the prevalence of diabetes has increased to 14.9% from 8.3% in 1996. Co-morbid psychological factors such as depression, anxiety, and stress have been shown to be high among type 2 diabetic patients in Malaysia and they were also associated with the level of glycemia. The present study sought to examine the relationships of diabetes distress and psychological well-being to glycemic control among adults with type 2 diabetes. A total of 60 adults with type 2 diabetes participated in the study and were given the diabetes distress scale (DDS-17) and well-being questionnaire (W-BQ 22) to measure their level of distress and psychological well-being using Pearson correlation test. The most recent data on glycemic control (or blood glucose level, HbA1c) were obtained from the participants’medical records, (with poor glycemic control defined by HbA1c>7.5%). Statistical Package for the Social Sciences (SPSS 19) used to analyze the data obtained from questionnaires. Pearson correlation results indicated significant positive relationship between blood glucose level and variables of diabetes distress (r=0.27, P=0.03) and psychological well-being (r=0.53, P=0.00). There were no significant relationships between blood glucose level and diabetes distress dimensions (emotional burden, physician-related distress, regimen-related distress, and internal distress). However, there were significant relationships between blood glucose level and variables of depression (r=-0.27, P=0.03) and anxiety (r=-0.41, P=0.00), both of which are dimensions of psychological well-being. The study results have shown that diabetes distress and psychological wellbeing are associated with glycemic control and while it is not always possible to avoid stress, learning to recognize and cope with stressors may help individuals with diabetes maintain good glycemic control and improve general well-being. These results are consistent with the results of past studies in Malaysia.abuse.

According to chronicity of diabetes and its effect on quality of life, in this study, we aimed to determine some predicting factors of quality of life in patients with type 2 diabetes. Our findings would facilitate planning intervention programs in health promotion field. This cross-sectional study assessed some predicting factors of quality of life among 140 diabetic patients affiliated to an outpatient diabetic center in Isfahan (Iran) in 2011. The instrument for data collection was a multidimensional scale including sociodemographic and health-related data (12 items), diabetes distress (17 items), self-efficacy (8 items), and quality of life (15 items). The collected data was analyzed by statistical tests in SPSS11.5. Our findings showed that some variables such as diabetes distress (P < 0.001) and self-efficacy (P < 0.001) had statistically significant relations with quality of life. The predictive power (R2) was equal to 0.66 in this study. In the multivariate regression model adjusted for other factors, self-management was found to be affected by diabetes distress (β = -0.277; P = 0.01) and self-efficacy (β = 0.161; P < 0.001). Pearson's correlation coefficient revealed that diabetes distress had a linear and reverse with quality of life (r = -0.341; P < 0.001). On the other hand, self-efficacy had a linear and direct relationship with quality of life (r = 0.63; P < 0.001). This study proposed decreasing diabetes distress and enhancing self-efficacy as important factors in improving quality of life and planning interventional programs among patients with type 2 diabetes.

Patient empowerment is an effective way to reach behavioral changes in diabetes control. The purpose of this study was conducted to investigate the effect of the educational program based on the empowerment model on distress and diabetes control in patients with type 2 diabetes. A RCT was conducted with 140 patients with type 2 diabetes randomly allocated to intervention and control group. In the intervention group, patients were divided to five groups with 14 patients in each group and participated in the empowerment model-based education program. In the control group, the traditional education was held. Patients’ empowerment and diabetes control were assessed using the diabetes distress questionnaires and HbA1C, respectively. It was revealed that a diabetes distress was reduced significantly in the intervention group in comparison to the control group. It was also found that with decreasing diabetes distress, the level of HbA1C diminished in the intervention group. Education based on the empowerment model in the intervention group resulted in reducing diabetes distress and improving diabetes control in comparison to the traditional education.

We explored the level of Jordanian patient's knowledge, diabetes related distress, self-management activities and these effects on the A1C level. This descriptive cross-sectional correlational design (conducted in 2013) was utilized to recruit 289 diabetic patients from outpatient diabetes clinics, using self-reported questionnaires (Diabetes Knowledge Test, Diabetes Distress Scale, and Diabetes Self-Management Questionnaire) in addition to chart review for selected variables. Participant's had mean glycated hemoglobin of 7.88%. Good glycemic control was significantly associated with higher self-management activities (r= -.147), high income (r= -.171), older age (r= -.252), shorter duration of illness (r=. 153), and low levels of distress. Despite these relationships only age, duration of illness and income significantly predicted A1C (F (5, 284) = 11.57, P<.001, R2 =. 17). Further, diabetes knowledge, diabetes-related distress, and self-management could not predict A1C level. Only diabetes-related distress and self-management correlated with patient's A1C, with no predictive power. Thus, further research is required to shed the light on the large unexplained components of the A1C variance.

The coexistence of mental health problems in diabetic patients can lead to poor disease management. This study aimed at investigating the mediating role of resilience and diabetes distress in the relationship between depression and treatment adherence in type 2 diabetes among Iranian patients.

It is a type of analytical study conducted from 2019 to 2020. The statistical population of this study consisted of all-diabetic patients in Tehran. The subjects (200) were selected after purposeful clinical evaluation and qualification of research. In this study, Beck Depression Inventory (BDI), the Persian Version of the Morisky Medication Adherence Scale-8, Diabetes Distress Scale (DDS), Conner & Davison Resilience Scale (CDRS) were used to collect the data. Pearson correlation test by SPSS version 24 and Confirmatory Factor Analysis in AMOS software version 22 were used for analysis (P<0.05).

In the present study, most participants (about 36.5%) were in the age group of 56-65 and 58.5% of them were female. According to the results, the variables of depression and diabetes distress has a negative and significant correlation with adherence to treatment (r= -.408, p<0.05). The resiliency has a positive and significant correlation with adherence to treatment (r= 0.414, p<0.05).

The findings showed a link between depression, diabetes distress, resilience, and treatment adherence. Resilience and anxiety from diabetes play a mediating role between depression and adherence to care.  Paying attention to patient resilience may lead to improved depression and diabetes distress in patients with diabetes, to increase the patient’s involvement in treatment adherence.

Type II diabetes is one of the chronic diseases, and diabetes distress is one of the psychological factors affecting its management. Therefore, this study was performed to compare the effectiveness of self-healing with mindfulness-integrated cognitive behavior therapy on diabetes distress and control of glycemic in type II diabetic patients

This semi-experimental research was conducted on 60 people with type II diabetes who were selected purposefully. People were randomly divided into two intervention groups and one control group. The intervention groups received twelve 90-minute sessions (one session per week) of mindfulness-integrated cognitive behavior therapy and self-healing. The research tools were Polonsky et al.'s Diabetes Distress Scale (2005), which has content validity and reliability with a Cronbach's alpha of 0.87, and laboratory equipment to measure hemoglobin glycoside. The data were analyzed using variance analysis with repeated measurements and post hoc tests in SPSS-24 software.

Between the two methods of intervention, only self-healing could effectively reduce glycosidic hemoglobin (P≤0.01). Moreover, both methods of intervention reduced diabetes distress; however, the effect of self-healing remained stable over time (P≤0.01).

The results indicated that self-healing was able to reduce hemoglobin glycoside in addition to diabetes distress and its effect remained constant over time. It is suggested to investigate the effect of self-healing in other areas related to diabetes.

Patients with diabetes experience some level of emotional distress varying from disease-specific distress to general symptoms of anxiety and depression. Since empirical data about symptom distress in relation to diabetes are sparse in Iran, this study was designed to assess the diabetes-specific distress in Iranian population. Persian version of Diabetes Distress Scale (DDS) questionnaire was completed by volunteer outpatients on a consecutive basis between February 2009 and July 2010, in Endocrine Research Center (Firouzgar Hospital). Then, scheduled appointments were made with a psychiatrist in the same week following completion of the questionnaire. The psychiatrist was not aware about the results of this questionnaire and patients were interviewed based on DSM-IV criteria. One hundred and eighty-five patients completed the questionnaire and were interviewed by a psychiatrist. Fifty-two percent of the patients were females. The mean age was 56.06 (SD=9.5) years and the mean of duration of diabetes was 9.7 (SD=7.3) years. Sixty-five (35%) had distress. Among the patients with distress, 55% were females and 64% had lower grade of education. Eighty patients were diagnosed as having Major Depressive Disorder. There was a relation between Emotional Burden subscale and age (P=0.004), employment status (P=0.03), and also diabetes duration (P=0.02). The physician-related distress subscale was also related to the type of medication (P=0.009) and marital status (P=0.01). It has been shown that the regimen-related distress subscale was also related to age (P=0.003) and duration of diabetes (P=0.005). High prevalence rate of distress in the study highlights the significance of the need for identifying distress and also other mental health conditions in patients with diabetes in order to take collaborative care approaches.

The purpose of this study was to assess self-care practices and their relative components among type 2 diabetic patients. We hypothesized that some sociodemographic and health-related factors, high diabetes distress, and low self-efficacy would be associated with poorer self-care practices.

A cross-sectional study was conducted for a period of 6 months in 2011. Study population was type 2 diabetic patients referring to Omolbanin center, an outpatient diabetic center in Isfahan. One hundred forty diabetic patients met the inclusion criteria and were all included in the study. Patients' self-care practices were measured by Summary of Diabetes Self-care Activities (SDSCA) self-report scale that includes items on the following aspects of the diabetes regimen: General diet, specific diet, exercise, blood glucose testing, foot care, medications, and smoking. Diabetes distress measured by Diabetes Distress Scale (DDS) scale and Stanford diabetes self-efficacy scale was used for scoring this issue. Collected data were analyzed by using SPSS software version 11.5.

Participants were between the ages of 37 and 75 years, with a mean of 53.23 years (SD=7.82). Fifty-four percent (n=76) were females; 97.1% were married (n=136), and 53.6% had education lower than diploma (n=75). Mean of duration of diabetes was 7.1 (SD=5.63) years. "Medications" subscale was considered as the most important one in measuring diabetes self-care practices (5.24 ± 2.38 days/week). Study findings revealed that general diet had significant relation with comorbidity, type of treatment, body mass index (BMI), fasting blood sugar (FBS), (Blood Sugar) (BS), waist circumference, diabetes distress, and self-efficacy. Specific diet had significant relation with comorbidity, education, triglyceride (TG), diastolic blood pressure (DBP), and low density lipoprotein (LDL). Exercise showed significant relation with history of diabetes, education, type of treatment, disease duration, TG, BMI, and BS. Also, blood glucose testing showed significant relation with disease duration, self-efficacy, TG, DBP, BS, LDL, and high density lipoprotein (HDL). On the other hand, foot care was related to age, diabetes distress, TG, BMI, HDL, and diabetes complications. Medications subscale as the most important subscale of self-care practices was relevant with age, disease duration, diabetes complications, type of treatment, FBS, HDL, and self-efficacy. The last subscale, smoking, had significant relation with sex, diabetes complications, diabetes distress, self-efficacy, TG, total cholesterol, BS, and HDL.

This information should be used in clinical practice when targeting and designing educational and care plan for patients with type 2 diabetes.

 Coronavirus disease 2019 (COVID-19) is a risk factor for long-term complications and mortality in people with diabetes. Diabetes self-management can prevent the adverse effects of COVID-19.

 This study aimed to investigate the association between COVID-19-related personal, familial, and psychological factors and diabetes self-management.

 The research was conducted using the simple non-probability sampling method at the Institute of Endocrinology and Metabolism of Iran University of Medical Sciences. A total of 102 people with type-2 diabetes participated in the study. Their inclusion criteria were a diagnosis of type-2 diabetes for at least one year, an age of 30 to 65 years, literacy, and no personal or family history of COVID-19 for the past two months. The Diabetes Self-management Questionnaire assessed the participants' self-management behaviors. Their personal and family data were recorded in a personal information form. The Diabetes Distress Scale and the Patient Health Questionnaire measured diabetes distress and depressive symptoms, respectively. COVID-19-related psychological factors were evaluated using the COVID-19-related Psychological Distress Scale, the Coronavirus Anxiety Scale, and the Fear of COVID-19 Scale.

 The Pearson correlation test showed that the number of times one or their family members were infected or hospitalized due to COVID-19, diabetes distress, and depressive symptoms were negatively related to diabetes self-management. Doses of COVID-19 vaccine injection were also positively related to self-management and negatively correlated with depressive symptoms and diabetes distress (P < 0.05). Multivariate linear regression analysis revealed diabetes regimen and interpersonal distress, COVID-19-related psychological distress, and the number of one's family members with chronic disease as the predictors of diabetes self-management (adjusted R2 = 96%, P < 0.001).

 People with diabetes can improve their participation in self-management activities by taking care of themselves and their families against COVID-19 and controlling negative emotions. COVID-19 vaccination can reduce the depressive symptoms and diabetes distress in people with type-2 diabetes and facilitate their participation in self-management.

Considering the chronic nature of diabetes and its significant effect on quality of life of patients, the present study was conducted to evaluate predictors of quality of life in these patients in order to facilitate planning health promotion intervention programs.

The present study was designed as a cross‑sectional study on 140 type 2 diabetic patients of Om‑ol‑Banin Diabetes Center of Isfahan. Data collection tool was a multidimensional questionnaire including demographic and disease related data (12 items), the standard scale for diabetes distress (17 items), the standard scale for self‑efficacy in diabetic patients (8 items), and standard scale for specific quality of life of diabetic patients (15 items). Collected data were evaluated by SPSS version 11.5 using the Chi‑square test, Independent T‑test, ANOVA, Pearson correlation and multivariate regression analysis.

Results showed that the quality of life of diabetic patients had a statistically significant correlation with diabetes distress variable (P < 0.001) and self‑efficacy variable (P < 0.001). In this study R2 (predictive power) was 0.66. Multivariate regression model indicated diabetes distress (b = ‑0.277, P = 0.01) and self‑efficacy (b = ‑0.161, P < 0.001) as variables influencing adjusted self‑management for other variables.

The result of the present study urges that in planning health promotion interventions in the field of diabetes, more attention be paid to self‑efficacy and diabetes distress variables in order to improve the efficiency and effectiveness of the interventions carried out.