SUN-663 - Evaluating the Prevalence of Diabetes Distress and Its Risk Factors in the Caribbean

Objectives:
Diabetes-related distress (DD) refers to the psychological impact of having to live with, and cope with the self-management of diabetes. Despite its impact on diabetes outcomes, there is a paucity of data in the Caribbean. Our objectives were to estimate its prevalence in patients attending a tertiary care diabetes clinic in Jamaica, and to determine its risk factors.

Methods:
This was a cross-sectional study in 256 participants, attending the University Hospital of the West Indies’ diabetes clinic in 2025. A single interviewer (SMLM) administered the standardized Diabetes Distress Scale-17 (DDS17) Questionnaire, and a screening 2-item questionnaire (DDS2). Biographical data and medical history were obtained from the electronic medical records. Univariate correlations and multiple variable regression analyses were used to explore the associations with DD.

Results:
The sample consisted of 256 adults, age (mean +/- SD) 55.3 +/- 17.0 years, 67% women, 15% had type 1 diabetes, age at diagnosis 40.5 +/- 16.6 years, duration of diabetes 14.9 +/- 12.1 years, waist 96.5 +/- 14.9 cm, and weight 78.8 +/- 20.2 kg. Their A1c measured closest to the interview was 9.0 +/- 3.2%.

Using the DDS17, the mean score for DD was 2.6 (95% CI: 2.5 - 2.7). About 75 (29%) had no DD (i.e. score < 2), 106 (41%) had moderate DD (i.e. >/= 2.0 and < 3.0), and 74 (29%) had severe DD (i.e. >/= 3.0). Among those with DD, the prevalence by domain was: regimen distress 54%, physician distress 42%, emotional burden 31%, and interpersonal distress 23%.

There were no significant correlations of DD with age, waist, weight, and duration of diabetes, but DD was correlated with age at diagnosis (r = -0.18; P = 0.004), A1c (r = 0.23, P < 0.001), type of diabetes (83% prevalence in type 1 vs. 68% in type 2 diabetes; P = 0.05). Other significant univariate factors were the presence of hypertension, meal perception, insulin use, platelet count, ALT/AST ratio, and support perception. Using multivariable logistic regression, only platelet count, ALT/AST, support perception, and meal perception remained independent variables.

Using the DDS2, 68% of participants had moderate to severe DD. In comparison with DDS17, the sensitivity of DDS2 was 86%, specificity 63%, PPV 83% and NPV 67%. The Cohen’s Kappa was 0.50 (P < 0.001) indicating moderate agreement. In a Bland-Altman plot, the t-statistic was 11.6 (P < 0.001), but the DDS17 had lower scores than DDS-2.

Conclusions:
Most diabetic Jamaicans in this sample had moderate to severe diabetes distress, and the prevalence is higher than many countries. These data indicate that clinicians need to consider their patients’ mental well-being, and can screen with the DDS2. Confirmation of screen-positive patients and their more detailed assessment can be done with the DDS17.

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