Prevalence and predictors of diabetes distress and depression in people with type 1 diabetes.

Background: People living with diabetes often encounter psychosocial challenges, including diabetes distress and depression. Despite this, little research has focused on the co-occurrence of these conditions. This study aimed to explore the prevalence of depressive symptoms and diabetes distress in people with type 1 diabetes in Kuwait and to identify clinical and demographic factors associated with these conditions. Methods: A total of 832 people with type 1 diabetes (females: 54.1%, mean age: 29 ± 8.5 years), were invited to participate in Dose Adjustment for Normal Eating (DAFNE) course. Diabetes distress was measured using the Problem Areas in Diabetes (PAID) scale and depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Depressive symptoms were defined as PHQ-9 scores ≥10. Data on biomedical outcomes, lifestyle factors, and sociodemographic information were collected. Results: The prevalence rates of diabetes distress and depressive symptoms were 27.8% and 38.3%, respectively. Notably, 19.6% of people experienced both conditions. In the regression analysis, PAID scale and PHQ-9 scores were significantly associated, patients with higher score on depressive symptoms scale were more likely to suffer diabetes distress (B= 2.65, p < 0.001). Female sex (odds ratio [OR]= 2.2, 95% CI= 1.5, 3.2), higher hemoglobin A1c levels (OR= 1.6, 95% CI= 1.0, 2.5), obesity (OR= 1.7, 95% CI= 1.1, 2.8), inactivity (OR= 2.4, 95% CI= 1.6, 3.6), microvascular complications (OR= 2.8, 95% CI= 1.5, 5.4), and lipohypertrophy (OR= 1.7, 95% CI= 1.1, 2.5) were associated with greater odds for the co-occurrence of diabetes distress and depressive symptoms (p< 0.05 for all). Conclusion: The majority of people with type 1 diabetes in Kuwait experience both diabetes distress and depressive symptoms. The strong correlation between diabetes distress and depressive symptoms suggests mutual predictability. The co-occurrence of both symptoms is associated with many sociodemographic and clinical factors.

Association of Physical Activity and Sleep Metrics with Depression in People with Type 1 Diabetes.

Objective: This study aimed to investigate the association of physical activity and sleep metrics, measured via wrist-worn accelerometers, with depression in people with type 1 diabetes. Patients and Methods: People with type 1 diabetes were recruited from the Dasman Diabetes Institute in Kuwait and were invited to wear a wrist-worn accelerometer device for 7 days. Mean physical activity (overall acceleration), inactivity, light activity, moderate activity, vigorous activity, the distribution of physical activity intensity (intensity gradient), sleep duration and sleep efficiency were quantified from the accelerometer data. The associations of these metrics with depression were investigated using multiple linear regression. Results: A total of 551 people with type 1 diabetes (age 33.1 (9.5) years) were included. Overall physical activity (B = -0.09, CI = -0.14 to -0.04), moderate intensity activity (B = -0.02, CI = -0.02 to -0.01), vigorous intensity activity (B = -0.16, CI = -0.27 to -0.05), and the intensity gradient (B = -2.11, CI = -3.51 to -0.72) were negatively associated with depression score (p < 0.01) and these associations remain significant even after adjustment for age, sex, diabetes duration, and BMI. However, sleep duration and efficiency were not associated with depression. After mutual adjustment overall physical activity (B = -0.07, CI = -0.12 to -0.01), but not the intensity gradient (B = -0.90, CI = -2.47 to 0.68), remained associated with depression. Conclusion: Overall, moderate and vigorous physical activity, and the intensity gradient were associated with lower symptoms of depression. Overall physical activity, rather than the distribution of activity intensity, appears more important in depression. This information can help guide physical activity interventions to improve depression in people with type 1 diabetes.

Validity of the Arabic International Physical Activity Questionnaire to Measure Moderate-to-Vigorous Physical Activity in People with Diabetes.

Purpose: The aim of this cross-sectional study was to compare the Arabic version of International Physical Activity Questionnaire (IPAQ) measured moderate-to-vigorous physical activity (MVPA) with accelerometer-measured MVPA in people with diabetes. Methods: From 2020 to 2022 physical activity was measured people ≥18 years with type 1 or type 2 diabetes in Kuwait. Self-reported MVPA was measured over 7 days with the Arabic version of the IPAQ. During the same 7-day period wrist worn accelerometers were used to objectively measure MVPA. IPAQ MVPA was calculated both including and excluding walking physical activity. MVPA measures were compared by limits of agreement approach, Pearson correlations and concordance correlations. Results: We recruited 240 participants with type 1 diabetes and 343 participants with type 2 diabetes for the study. In people with type 1 diabetes, there were no concordance correlations between IPAQ MVPA, both including (rho = -0.011 (-0.038, 0.017), p = 0.444) and excluding (rho = -0.001 (-0.067, 0.065), p = 0.978) walking physical activity. MVPA measured by IPAQ was 43.3(-85.6, 172.2) min/day higher than accelerometer-measured MVPA, when including walking, and 8.88(-60.4, 78.2) min/day higher, when excluding walking. In people with type 2 diabetes, there were significant positive concordance correlations between IPAQ MVPA, both including (rho = 0.038 (0.02, 0.06), p < 0.001) and excluding (rho = 0.34 (0.27, 0.41), p < 0.001) walking physical activity. MVPA measured by IPAQ was 62.3 (95% CI -61.5 to 186.0) min/day higher than accelerometer-measured MVPA, when including walking, and 4.0 (95% CI -34.1 to 42.0) min/day higher, when excluding walking. Conclusion: In people with type 1 or type 2 diabetes, caution should be exercised when using the Arabic version of the IPAQ to measure MVPA.