Clinical phenotyping of people living with type 1 diabetes according to their levels of diabetes-related distress: results from the SFDT1 cohort
Year: 2025
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Type 1 diabetes is burdensome, requiring complex daily management and making people more prone to emotional distress. To better detect diabetes-related distress (DD) and identify at-risk patients, we aimed to provide an in-depth characterization of DD in people with type 1 diabetes. RESEARCH DESIGN AND METHODS: cohort who filled in the Problem Areas in Diabetes questionnaire (PAID ≥40 indicates high DD). Age and sex-adjusted multivariable logistic regression models analyzed individual characteristics, clinical indicators, diabetes-related complications and psychological factors. We further analyzed DD according to six data-driven subdimensions: emotional distress, fear of complications, social distress, eating distress, management distress, and diabetes burnout. RESULTS: In total, 1220 participants (50.6% female, age 42 years (SD 13.9), diabetes duration 24.7 years (13.6)) had a total mean PAID score of 39.6 (21.7) and 592 (48.5%) reported high DD. Leading subdimensions of DD included fear of complications (50.1 (24.4)) and diabetes burnout (45.9 (24.5)). Females, younger age, social vulnerability, smoking, and the presence of retinopathy were positively associated with high DD (p<0.05). We observed similar DD levels across HbA1c levels and treatment modalities, including automated insulin delivery and continuous glucose monitoring use. Several psychological factors, such as anxiety/depression, poor sleep quality, and treatment burden, were strongly associated with DD (p<0.001). CONCLUSIONS: We provide a holistic clinical phenotyping approach that enables the identification of determinants and prevalence of DD, overall and according to key DD subdimensions, in a large and diverse population. Our results underscore the importance of developing DD-targeted prevention and intervention strategies focused specifically on high-risk groups and the most impactful distress subdimensions to reduce the impact of type 1 diabetes burden. TRIAL REGISTRATION NUMBER: NCT04657783.
Institutions: University of Luxembourg, Luxembourg Institute of Health, Conservatoire National des Arts et Métiers, Inserm, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Université Sorbonne Paris Nord, Assistance Publique – Hôpitaux de Paris, Hôpital Avicenne, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche Épidémiologie et Statistique, Centre Hospitalier Universitaire de Rennes, Centre National de la Recherche Scientifique, Université de Montpellier, Centre Hospitalier Universitaire de Montpellier, Institut de Génomique Fonctionnelle, Institut Necker Enfants Malades, Dasman Diabetes Institute, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Hôpital Bichat-Claude-Bernard, Université de Bourgogne, Centre de recherche Translationnelle en Médecine moléculaire, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, Centre Hospitalier Universitaire de Caen Normandie, Hôpital Lariboisière
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
Awards: G110350785, G7739771026
OpenAlex ID: W4407934643