Date of Award

3-2025

Degree Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Advisor

Dr. Eric Njenga

Second Advisor

Dr. Jacob Shabani

Third Advisor

Dr. Samuel Mucheru

Department

Family Medicine (East Africa)

Abstract

Background Diabetes distress encompasses a spectrum of emotional and psychological challenges faced by individuals managing diabetes, including anxiety, stress, depression, frustration, and feelings of helplessness. This distress arises from the constant demands of monitoring blood sugar levels, managing medications, adhering to dietary restrictions, engaging in regular physical activity, and navigating potential complications. Social and emotional factors such as stigma, discrimination, and concerns about future health further contribute to this burden. Factors like fear of hypoglycemia, financial strain, fluctuating blood sugar levels, anxiety about complications, and impacts on personal relationships exacerbate diabetes distress. Left unaddressed, diabetes distress can lead to poor self-management and non-adherence to treatment regimens. Healthcare providers are pivotal in recognizing and addressing distress, fostering supportive environments, and promoting open communication to enhance diabetes care and patient outcomes.

Objectives To determine the Prevalence and Predictors of diabetes distress in patients with type 2 diabetes attending a tertiary private hospital in Nairobi, Kenya.

Methods We conducted a cross-sectional study among 376 individuals with type 2 diabetes on followup at the Aga Khan University Hospital, Nairobi. Exclusions included pregnant women and those with anxiety, depression, or dementia. Diabetes distress was assessed using the Diabetes Distress Scale (DDS-17), and multivariate analysis was used to determine the independent predictors associated with diabetes distress. Bivariate correlation assessed associations between diabetes distress scores and socio-demographic, clinical, and biochemical data, with results presented as Crude Odds Ratios (cOR) and 95% Confidence Intervals (CI). Significant variables (p < 0.1) from univariate analysis were included in multivariate logistic regression, with Adjusted Odds Ratios (aOR) and 95% CI used to determine the strength of associations while controlling for confounders.

Results This study examined diabetes distress across individuals with varying diabetes durations. Most participants had long-term diabetes and relied on oral or injectable treatments, with few managing through lifestyle changes alone. Using the Diabetes Distress Scale (DDS-17), 86.2% reported no distress, 12.8% had mild distress, and 1% had severe distress, with emotional burden being the most common type. Nearly half had diabetes-related complications, predominantly neuropathy, followed by retinopathy and chronic kidney disease. Longer diabetes duration and complications correlated with higher distress, while comorbidities showed no significant impact. Individuals on combined oral and injectable therapies had increased distress odds. These findings emphasize the need for routine distress screening and psychological support to enhance diabetes management and well-being.

Conclusion This study found that 13.8% of people with diabetes attending a private, tertiary, outpatient clinic in Nairobi, Kenya, experience diabetes distress. Factors associated with diabetes distress were older age and poor sugar control. Distress was significantly associated with diabetesrelated complications (aOR 2.59, 95% CI 1.28–5.40, p = 0.01). Being widowed showed a borderline association. No significant associations were observed with sex, education, illness duration, comorbidities, or type of antidiabetic regimen. These results highlight the need for routine distress screening in diabetes care to improve treatment adherence and overall health outcomes

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