Baseline clinical factors associated with diabetes distress in dialysis patients: Insights from the ABCD audit data

Diabetes is the leading cause of end-stage renal disease (ESRD) in the United Kingdom, accounting for one third of individuals starting renal replacement therapy (RRT). Data on the prevalence of diabetes distress (DD) in people with Diabetic Kidney Disease (DKD) on dialysis are scarce.

To describe the prevalence of DD in people living with diabetes undergoing haemodialysis.

We used baseline data from the Association of British Clinical Diabetologists nationwide audit of people with diabetes in the United Kingdom. Analysis was limited to people who were started on intermittently scanned continuous glucose monitoring (isCGM) who were undergoing haemodialysis. DD was assessed using the two-item diabetes distress scale (DDS-2). High DD was defined as a DDS score ≥3, while low DD was DDS score <3. Comparisons were made between patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Chi-square test was used to assess the difference between categorical variables, and a t test for continuous variables.

Eighty-six people with diabetes who were on haemodialysis were included in this study. Forty-eight had T1DM whereas thirty-eight had T2DM. Overall, 31 (36%) were female. The mean age was 60.7 years ± 15.5. The duration of diabetes was significantly shorter in the T2DM group (20.6 years ± 8.8) compared to the T1DM group (25.8 years ± 13.6) (p = 0.04). Overall, the average DDS score was 2.7 (±1.59). The prevalence of severe DD (DDS ≥ 3) was 42%. DD among those with T1DM was 43% compared to 40% in T2DM (p = 0.96). Body mass index was negatively correlated with high DD (p < 0.001).

Diabetes distress is highly prevalent among individuals with diabetes on haemodialysis and appears to be influenced more by the challenges of dialysis than traditional diabetes-related factors. These findings highlight the need for routine screening and tailored psychological support for this vulnerable population to improve emotional well-being and overall care outcomes.