# Understanding Diabetes Distress: A Study of Contributing Factors Among Adults With Type 2 Diabetes in Rural East Godavari, Andhra Pradesh

## TL;DR

This study found that diabetes distress is common among rural adults with type 2 diabetes, especially affecting women and linked to certain medications and sociodemographic factors.

## Contribution

The study identifies specific sociodemographic and clinical factors, including medication combinations, associated with diabetes distress in a rural Indian population.

## Key findings

- Diabetes distress was present in 63.1% of participants, with emotional burden being the most significant domain.
- Female patients reported higher rates of severe distress compared to male patients.
- Combination therapies involving sulfonylureas were associated with higher odds of diabetes distress.

## Abstract

Background: Type 2 diabetes mellitus (T2DM) requires sustained self-management, and diabetes distress is a diabetes-specific psychological burden that can impair coping adherence and outcomes. This study aimed to estimate the prevalence and severity of diabetes distress and evaluate factors associated with distress among adults with T2DM attending rural health centres.

Methods: A community-based cross-sectional study was conducted from March 2025 to December 2025 in rural health centres affiliated with Konaseema Institute of Medical Sciences and Research Foundation, East Godavari District, Andhra Pradesh, India. Adults aged 20-60 years with T2DM were enrolled consecutively (n=390). Diabetes distress was measured using the Diabetes Distress Scale-17 (DDS-17) and classified as no distress (mean item score <2.0), moderate distress (2.0-3.0), and severe distress (>3.0). Prevalence was reported with 95% CIs. Associations with distress categories were tested using chi-squared or Fisher's exact tests. For OR estimation, DDS-17 was dichotomized as any distress (≥2.0) versus no distress (<2.0), and logistic regression was applied.

Results: Among 390 participants, 242 (62.1%) were male patients and 148 (37.9%) were female patients, with a mean age of 40.0 ± 11.6 years. Any diabetes distress was present in 246 participants (63.1%; 95% CI 58.2-67.7), of which moderate distress was seen in 210 (53.8%; 95% CI 48.9-58.7) and severe distress in 36 (9.2%; 95% CI 6.7-12.5). Meanwhile, 144 participants (36.9%; 95% CI 32.3-41.8) reported no distress. Distress categories differed by gender (p<0.00004): among male patients, no distress was reported by 87 (36.0%), moderate distress by 149 (61.6%), and severe distress by six (2.5%); among female patients, no distress was reported by 57 (38.5%), moderate distress by 61 (41.2%), and severe distress by 30 (20.3%). Among distressed participants (n=246), the mean DDS-17 total score was 2.76 ± 0.30. Emotional burden was highest (3.20 ± 0.52), followed by interpersonal distress (2.92 ± 0.21) and regimen-related distress (2.82 ± 0.27), while physician-related distress was lowest (1.41 ± 0.78). On bivariate testing, education, socioeconomic position, marital status, BMI status, and diabetes duration were associated with DDS-17 categories (all p<0.00001). For example, moderate distress was reported in 180 (63.4%) of literate participants (n=284), 100 (55.6%) of middle-class participants (n=180), 150 (48.4%) of married participants (n=310), and 80 (53.3%) of those with 3-6 years of diabetes duration (n=150). It was also found that the combination of metformin and sulfonylurea was associated with higher odds of any distress (OR 2.63; 95% CI 1.48-4.68; p<0.001), and the combination of metformin, sulfonylurea, and statin also showed higher odds (OR 1.93; 95% CI 1.18-3.16; p=0.009).

Conclusions: Diabetes distress was common among rural adults with T2DM, with emotional burden as the dominant domain and severe distress disproportionately concentrated among female patients. Distress severity showed meaningful associations with key sociodemographic and clinical factors, and sulfonylurea-based combination regimens were linked to higher odds of distress. Routine DDS-17 screening with severity-guided and domain-targeted support should be integrated into rural diabetes care, alongside longitudinal studies incorporating glycemic measures, complications, and mental-health covariates to clarify causal pathways.