Diabetes Distress, Self-Care Behaviors, Quality of Life, and Clinical Encountersas Correlates of Glycemic Control among South Indian Adults with Type 2 Diabetes Mellitus
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Abstract
Objectives: The objective of the study was to investigate how emotional distress, self-management strategies
and clinician interactions in glycemic control and quality of life in South Indian adults with Type 2 diabetes
using a mixed methods approach. Methods: We carried out a sequential exploratory mixed-methods study among
250 adults with Type 2 diabetes attending two tertiary care centers in Chennai, India. The development of a
quantitative survey was guided by qualitative interviews with 20 participants. We measured diabetes distress
(Diabetes – related distress [DDS]-17), self-care summary of diabetes self-care activities (SDSCA), quality of life
EuroQOL-5 dimension- 5 level (EQ-5D-5L) and glycated hemoglobin (HbA1c). Linear and logistic regression
were used to identify predictors of HbA1c and quality of life, while qualitative themes helped explain the
quantitative associations. Results: Mean HbA1c was 8.2 ± 1.5%; HbA1c <7.0% was achieved in 35.2%. The
mean DDS-17 was 2.7 ± 0.9, indicating moderate distress. Qualitative data revealed diagnosis as a biographical
disruption that shattered social identity around food. Glucose readings were interpreted as moral judgments and
produced guilt. Higher DDS-17 was independently linked to elevated HbA1c (β = 0.21, P = 0.002) and lower
EQ-5D-5L utility (0.65 vs. 0.81; P < 0.001). SDSCA was the strongest predictor, with each additional day/week
associated with 0.38% lower HbA1c (β = −0.35, P < 0.001). Participants distinguished transactional metric-driven
care from person-centered communication that increased agency. Conclusion: Poor glycemic control was driven
by diabetes distress, moralized self-management and transactional clinical encounters. Routine distress screening,
communication training to demoralize self-monitoring, and peer-support models are needed. Effective diabetes
care must take into account the psychological and social architecture of self-management, not simply glucose.
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