Association Between Psychological Distress and Glycaemic Control Among Adults with Diabetes Mellitus in Saudi Arabia

Background: Diabetes mellitus is a chronic metabolic disorder often accompanied by psychological distress, including stress, anxiety, and depression. Such emotional symptoms can influence self-care behaviours and metabolic control. In Saudi Arabia, cultural and religious practices may mitigate the effects of psychological distress on glycaemic regulation. Limited evidence exists regarding the simultaneous assessment of depression, anxiety, and stress in relation to objective glycaemic indicators such as HbA1c among adults with diabetes in Saudi Arabia. This study aimed to determine the association between psychological distress and glycaemic control among adults with diabetes, while exploring the influence of demographic and biochemical factors. Methods: A cross-sectional study was conducted from 21 January 2026 to 19 April 2026 among 546 adults diagnosed with diabetes in multiple healthcare settings in Riyadh, Saudi Arabia. Psychological distress was assessed using the DASS-21 questionnaire, while glycaemic control was measured using HbA1c, categorised as controlled (<7%) or uncontrolled (≥7%). Demographic, anthropometric, and biochemical parameters including BMI, blood pressure, and lipid profile were collected from medical records and standardized assessments. Associations were examined using chi-square tests and multiple linear regression analysis was performed including psychological distress scores, BMI, blood pressure measurements, and lipid profile parameters to identify factors associated with HbA1c variation. Results: Psychological distress was prevalent; however, stress (6.2-10.7%), anxiety, and depression were significantly associated with variation in HbA1c levels. In contrast, nationality, total cholesterol, LDL, triglycerides, and systolic blood pressure were significantly associated with HbA1c. Multiple regression showed that stress (B = 0.09, p = 0.015), systolic blood pressure (B = 0.146, p = 0.006), and total cholesterol (B = 0.229, p < 0.001) were independent predictors, collectively explaining 14.8% of HbA1c variance. Multiple regression analysis identified stress, systolic blood pressure, and total cholesterol as significant factors associated with variation in HbA1c levels. Conclusions: While psychological distress is common among adults with diabetes, its direct impact on HbA1c may be attenuated in populations with strong religious and cultural coping practices. Conversely, metabolic factors, particularly total cholesterol and systolic blood pressure, alongside stress, showed stronger associations with HbA1c levels in this study population. These findings underscore the importance of integrating physiological, psychological, and culturally contextualised strategies in diabetes management to optimize outcomes.