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Comparison of Diabetes Related Distress and Psychological Well-being among Patients with Type I and Type II Diabetes Mellitus.

Byline: Ayesha Batool and Riffat Sadiq

Abstract

Background: The chronic disease of diabetes mellitus aggravates both physical and psychological health of the patients. Irrespective to its type, patients diagnosed with diabetes are vulnerable to psychological chaos and disease related distress. So, the objective of the present study was to determine and compare the diabetes related distress and psychological well-being experienced by patients with type I and type II diabetes mellitus.

Patients and Methods:, Two hundred diabetes patients (n = 200), dwelling in Faisalabad, were recruited for the current study from January 2017 to July 2017 via purposive sampling method. Half of them (n = 100) diagnosed with type I diabetes, whilst half of them (n = 100) with type II diabetes. Comparative resea rch method with independent group design was applied whereby both groups were compared with each other Demographic information form, Diabetes Distress Scale and Psychological well-being scale were used as research instruments.

Results: Independent samples t-test exemplified that patients with type II diabetes mellitus significantly reported more emotional burden (t = -10.861, df = 198, p = .000) than type I diabetes. Patients suffering from type II diabetes also reported less autonomy (t = 4.941, df = 198, p = .000), environmental mastery (t = 1.071, df = 198, p = .000) and purpose in life (t = .984, df = 198, p = .000) than patients with type I diabetic mellitus.

Conclusion: Type II diabetes mellitus is more detrimental for patients in terms of experiencing more emotional burden and poor psychological well-being (i.e, less autonomy, environmental mastery and purpose in life) than type I diabetes mellitus.

Key words: Type I diabetes, type II diabetes, diabetes distress, psychological well-being.

Introduction

Worldwide drastic upsurge of diabetic mellitus is alarming that has adversely affected the people of all genres. To see the numbers of reported cases, it sounds that disease is now beyond of any control. By the year of 2040, the expected ratio of diabetes mellitus will rise to 10.4%.1 Developing countries have been massively affected and amidst them, Pakistan is likely to be ranked fourth.2

Patients experiencing diabetes mellitus usually report higher levels of sugar in their blood for a longer period of time.3 Due to this, patients persistently need to urinate, to take food and water. Diabetic mellitus results in pancreatic deficiency blocking the release of sufficient insulin essential for human body.4

There are two main forms of diabetes mellitus people are commonly suffering from. Type I diabetes mellitus is formerly known as insulin-dependent/ juvenile/ early onset diabetes mellitus, whereas type II diabetes is formerly called as non-insulin dependent/adult onset diabetes.4 The level of glucose could not be sustained owing to the insulin resistance in the body.3

Most of the time, diabetic patients experience diabetes related distress owing to associated complications. Diabetes distress is usually linked with rigorous requirements, for instance, behavior management to regulate diet, exercises and so on.5 Patients with diabetic distress seems to report emotional burden, physician-related distress, regimen-related distress and interpersonal distress.6 Research evidences provided an association of diabetic distress with poor self-management behavior.7 As a result, patients remain worried pertaining to their disease.8 The level of motivation, health, life quality and psycological well-being gets declined owing to diabetes distress.9

A substantial literature highlights that psychological well-being enables a person to enjoy life, keep balance in daily activities and sustain psychological flexibility.10 Unfortunately, diabetic patients suffer from distress and psychological upheavals like depression.11 Co-morbidity of diabetes distress and psychological well-being is also evident among patients diagnosed with diabetes mellitus.12 Various psychological disorders such as; eating disorder,13 adjustment disorder, depressive disorder and generalized anxiety disorder14 and depression and anxiety15 have been reported by diabetic patients.

So far scientific literature elucidated the prevalence of diabetes mellitus and its physical and psychological complications. However, few researches have examined the psychological well-being among diabetic and non-diabetic patients.16

Paucity of scientific evidences pertaining to diabetes related distress and psychological chaos has spurred the investigation of distress and psychological health among both types of diabetic patients. The present scientific inquiry will provide knowledge concerning type I and II diabetes related distress and psychological repercussions. So, the key assumptions of the present study are as follows:

1. There would be a significant difference among type I and type II diabetic patients in respect to emotional burden, physician-related distress, regimen-related distress and interpersonal distress.

2. There would be a significant difference among type I and type II diabetic patients in respect to autonomy, environmental mastery, personal growth, positive relations with others, purpose in life and self-acceptance.

Patients and Methods

Purposive sampling method has been applied to recruit two hundred (n = 200) diabetic patients from different hospitals/clinics situated in Faisalabad. One hundred participants (n = 100) were suffering from type I diabetes mellitus, whereas rest of the patients were suffering from type II (n = 100) diabetes mellitus. They were between 21 to 50 years. At least 2 years of the duration of diagnoses (diabetes) was incumbent for selection. Patients with co-morbid chronic maladies for instance, hepatitis, cardiac problems, asthma, or diabetes related complications were not included. Infertile, widow/widower, divorcee and unemployed (for males) patients were also excluded at the time of selection.

Basic personal information from every participant (for example, age, gender, educational level, marital status, employment, duration of diabetes mellitus, type of diabetes mellitus, treatment procedure, co-morbid illness, associated physical complication, etc) was compiled with Personal Information Form. Urdu version17 of Diabetes Distress Scale (DDS)18 detected the diabetes distress among participants. There are 17 items of DDS with 4 subscales named: emotional burden (5-items), physician-related distress (4-items), regimen-related distress (5-items) and interpersonal distress (3-items). Responses are rated on 6 points of continuum (Not a problem = 1, a slight problem = 2, a moderate problem = 3, somewhat serious problem = 4, a serious problem = 5, a very serious problem = 6). Urdu Version has been reported as reliable research instrument ([alpha] = 0.73).

Psychological Well-being Scale was selected to measure the variable of psychological well-being among present sample. It has 42 items with 6 subscales (autonomy, environmental mastery, personal growth, positive relations, purpose in life and self-acceptance) to be also scored on 6-points of likert scale [Strongly disagree = 1, moderately disagree = 2, slightly disagree = 3, slightly agree = 4, moderately agree = 5, strongly agree = 6]. Reported reliability of Urdu version of PWB is translated version ([alpha] = .71).19

Having approval from Ethical Review Committee (ERC) of affiliated institution, research data was collected over a period of six months. In order to approach both types of diabetic patients, doctors of private clinics and hospital administration were contacted to make necessary arrangements for data collection. With their permission, meetings with registered patients were held at clinics and hospitals. Written consent for every patient was also taken while briefing research purpose, risk/benefit ratio, confidentiality and procedure for being volunteer participants of the study.

First, through Personal Information Form, some basic and necessary information related to disease was taken from patients and then inquired and confirmed by their doctors in order to control those factors which might influence the results of the current study. Then, participants were given other questionnaires to be answered on each item. Subsequently, descriptive statistics (frequency, percentage) of demographic information and independent samples t-test was calculated to test the research hypotheses through SPSS Version-20.0.

Results

Among all patients, 50% were males and 50% were females. Majority (53%) patients were between 31 to 40 years and most of them (38%) were matriculate. About 63.5% patients were married. About 50% patients were suffering from type I diabetes and 50% from type II diabetes. More than 5 years of duration of diabetes mellitus was observed for majority of the patients (58%). Though, half patients were experiencing type I diabetes who received treatment through only injection (50%). Among with type II diabetes, about 33.5% patients were taking oral treatment and 16.5% were receiving both kinds of treatment (oral and injection) to manage their disease (Table-1).

Table-2 reveals that type II diabetic patients significantly experienced more emotional burden (t = -2.046, df = 198, p = .042) as compare to type I diabetes patients. Both types of patients did not significantly differ on physician-related distress (t = -.147, df = 198, p = .253), regimen related distress (t = -.650, df = 198, p = .516) and interpersonal distress (t = - .655, df = 198, p = .513).

Table-3 also has shown a significant difference among patients with type I and II diabetes mellitus on subscales of psychological well-being. Patients with type I diabetes mellitus significantly have reported more sense of autonomy (t = 4.941, df = 198, p = .000), environmental mastery (t = 1.071, df = 198, p = .000) and purpose in life (t = .984, df = 198, p = .000) as compare to patients with type II diabetes mellitus. A non-significant difference has been noticed among both types of patients on the variables of personal growth (t =-.041, df = 198, p = .967), positive relations with others (t = .158, df = 198, p = .874) and self-acceptance (t =-.054, df = 198, p= .957) as well.

Discussion

The present paper probed the diabetes distress in patients with type I and II diabetes mellitus and found type II diabetic patients experiencing more emotional burden in comparison to type I diabetic patients (Table-1).

Table 1: Summary of personal and disease related Information. (n = 200)

###Characteristics###F###%

Age###21-30###53###26.5

###31-40###106###53.0

###41-50###41###20.5

Gender###Male###100###50.0

###Female###100###50.0

Educational level###Matric###76###38.0

###Intermediate 71###35.5

###Graduate###47###23.5

###Masters###6###3.0

Marital Status###Single###73###36.5

###Married###127###63.5

Type of diabetes###Type I###100###50.0

###Type II###100###50.0

Duration of disease###5 years###84###42.0

###5 years###116###58.0

Type of treatment###Oral###67###33.5

###Injection###100###50.0

###Both###33###16.5

Table 2: Summary of independent samples t-test showing difference among type I and II diabetic patients in relation to diabetes distress. (n = 100)

Diabetes Distress###Type I###Type II

###M###SD###M###SD###df###t###p

Emotional burden###21.25###3.05###22.16###3.23###198###-2.04###.042

Physician related distress###13.82###2.78###14.31###3.24###198###-.147###.253

Regimen related distress###20.69###3.03###20.97###3.05###198###-.650###.516

Interpersonal distress###11.32###2.22###11.09###2.71###198###-.655###.513

Table 3: Summary of independent samples t-test showing difference among type I and II diabetic patients in relation to psychological well-being. (n = 100)

Dimensions of Psychological###Type I###Type II

well-being###M###SD###M###SD###df###t###p

Autonomy###27.66###6.34###24.01###3.79###198###4.941###.000

Environmental mastery###25.08###3.78###24.55###3.18###198###1.071###.000

Personal growth###24.26###3.16###24.28###3.67###198###-.041###.967

Positive relations with others###25.74###3.29###25.66###3.82###198###.158###.874

Purpose in life###25.25###3.97###24.74###3.32###198###.984###.000

Self-acceptance###25.09###4.32###25.12###3.49###198###-.054###.957

It depicts that patients with type II diabetes mellitus seemed to be emotionally overwhelmed by their ailment. Intensive requirements for managing disease such as: controlling diet, physical activities, level of insulin/ glucose, and medicines might have escalated emotional burden and frustration among patients.6 Besides, associated difficulties are potent stressors leading distress among type II diabetic patients.20 Due to greater health care used and cost, type II diabetes has caused economic burden on health care system.2

Albeit, there is no definite time for the onset of type II diabetes, for this reason, sudden diagnosis may escalate apprehension and worries. A person who lived healthy for years may have difficulty in adopting the life style that necessitates abstinence. Contrary to that, type I diabetes is commonly diagnosed at early age, therefore, patients with the passage of time learn how to manage their illness. Before indulging in practical life, they might have polished their skills in order to cope up with daily life issues. The time comes when patients become adhered to treatment procedure and disease related management, as a result, their disease related emotional burden gets decreased. This is also justified by another study that investigated an association between diabetes mellitus and distress.21

Another aim of the current study was to compare the psychological well-being in patients with type I and type II diabetes mellitus. The findings (Table-2) revealed significant difference among type I and type II diabetic patients in respect to autonomy, environmental mastery and purpose in life (subscales of psychological well-being).

It could be said that patients with type I diabetes than type II diabetes, seem to be more confident and managed in response to social pressure, environmental tasks and well enough to direct own self according to their life purpose. The reason is that type I diabetes patients, from the beginning, are familiar to the affiliated complications of their disease. Having knowledge concerning disease at early stage of life make them habituated of new life style. These arguments are also supported by a previous study that depicted internal locus of control beliefs and disease related education to be connected with psychological well-being of patients with type I diabetes mellitus.22 Due to this, patients diagnosed with type I diabetes did not perceive greater influence of their disease on life.23

On the other hand, a significant influence of type II diabetes mellitus was observed on the psychological well-being of patients.24 As a result, they are more prone to stress, anxiety and depression.25 Knowledge of long terms snags may predict lower well-being 23 besides terrifying them.22

Resultantly, in the present research psychological well-being (i.e, autonomy, environmental mastery and purpose in life) of type II diabetes patients seemed to be lower than type I diabetes patients.

Considering present research findings, it can be concluded that both types of diabetes mellitus put different impact on patients. Type II diabetes patients experience more diabetes distress in form of emotional burden than type I diabetes patients. Conversely, type I diabetes patients seemed to be having more sense of autonomy, environmental mastery and purpose in life than type II diabetes patients. Physical Health Professionals need to consider the disparate influence of both types of diabetes mellitus on patient's behavior and psychological state while providing health care services to them.

Some significant limitations have been observed. For instance, sample size was not calculated to ensure random selection of the participants. Recruitment of two hundred patients was solely based on their diagnosis and other inclusive/ exclusive criteria set to meet the present purpose. Furthermore, the present study could not address the psychological health status and disease related distress among patients experiencing additional complications of diabetes such as; neuropathy, nerve damage, retinopathy, erectile dysfunction, cardiac problem or kidney damage. In future, impact of these complications along with diabetes on psychological health of patients must be investigated in order to enhance health care facilities.

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22. Pires-Yfantouda R, Evangeli M. The Role of Psychosocial Factors in Wellbeing and Self-Care in Young Adults with Type 1 Diabetes. Int J Diabet Res 2012; 1(1):1-6.

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Publication:Pakistan Journal of Medical Research
Article Type:Report
Date:Dec 31, 2018
Words:3445
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