Screening Adults with Type II Diabetes in Primary Care for Diabetes Distress

Abstract

Problem & Purpose: Diabetes remains a prevalent issue in the United States as one of the top ten leading causes of death and contributing to significant healthcare expenditures. At a primary care clinic in suburban Maryland, one-third of adults with type II diabetes (T2DM) had a glycated hemoglobin A1C (HbA1c) greater than or equal to 7%, above the current clinical guideline recommendations. Diabetes distress (DD) is directly linked to poor glycemic control and worse clinical and psychological outcomes but is not often assessed by clinicians. The short-form Problem Areas in Diabetes Scale (PAID-5) has been shown to detect DD in adult patients effectively. The purpose of this quality improvement (QI) project was to identify whether DD exists in this patient population and could be a contributor to poorly controlled T2DM. Methods: Screening adults with T2DM for DD was implemented in a suburban primary care clinic. A medical assistant educated in the screening process offered the self-administered PAID-5 survey to eligible adults. Exclusion criteria were pregnancy, acute visits, and patients not previously diagnosed with T2DM. The percentages of patients offered the survey and those who completed it were calculated. HbA1c levels were paired with each participant’s PAID-5 score. Results: A total of 105 eligible patients were seen over 14 weeks. Of those, 49% were offered the PAID-5, and 36% completed it. Significant DD was indicated in 18%, and of those, 100% endorsed the item, “Worrying about the future and the possibility of serious complications”. Mean HbA1c for all patients, those with and without DD were 7.2%, 7.5%, and 7.1%, respectively. Conclusion: DD exists in the clinic and patients with DD have higher mean HbA1c levels. Limiting factors include staff absences and time constraints. Future QI projects should aim to minimize DD by using PAID responses to identify barriers, guide patient discussions, and make needed referrals.