Diabetes distress is associated with food insecurity in Iranian adults with type 2 diabetes: a cross sectional study adjusted for socioeconomic determinants

IF 2.2 Q4 ENDOCRINOLOGY & METABOLISM

Diabetes epidemiology and management Pub Date : 2026-01-01 Epub Date: 2026-05-15 DOI:10.1016/j.deman.2026.100317

Mehran Alijanzadeh , Amaneh Behpoor , Fereshteh Attaran , Samira Saremi , Leila Modarresnia , Zainab Alimoradi

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Abstract

Introduction

Diabetes distress represents a significant psychological burden that adversely affects self-management and clinical outcomes. Food insecurity has been proposed as factor associated with this distress. This study aimed to examine the association between food insecurity and diabetes distress in individuals with type 2 diabetes adjusted for socioeconomic factors.

Methods

In this cross-sectional study, 207 adult patients with type 2 diabetes attending outpatient endocrinology clinics in Qazvin, Iran, were enrolled during 2025 via convenience sampling. Data on socioeconomic status, food insecurity (using a validated household access scale), and diabetes distress (using the 17-item Diabetes Distress Scale) were collected through interviewer-administered questionnaires. Multivariable linear regression was employed to identify factors independently associated with overall and domain-specific diabetes distress.

Results

Participants had a mean age of 55.70 (±15.95) years, diabetes duration of 7.87 (± 5.37) years, and a BMI of 28.92 (± 4.14) kg/m². After adjustment for covariates, significant factors associated with greater overall diabetes distress included: positive screen for depression (β = 0.20, 95% CI [0.11, 0.48], p = 0.002), rural residence (β = 0.17, 95% CI [0.08, 0.47], p = 0.006), and food insecurity (β = 0.16, 95% CI [0.05, 0.45], p = 0.016). Conversely, better self-perceived health status (β = -0.27, 95% CI [-0.64, -0.22], p < 0.001) and use of oral hypoglycemic agents versus insulin (β = -0.13, 95% CI [-0.38, -0.02], p = 0.032) were associated with lower distress.

Conclusion

Our findings suggest that integrated care approaches may be warranted including routine screening for depression and food insecurity using validated tools (e.g., PHQ-4 and HFIAS) during diabetes visits, targeted food assistance programs for vulnerable households, and patient education programs designed to improve self-perceived health status, particularly in rural populations.

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糖尿病困扰与伊朗2型糖尿病成年人的粮食不安全有关：一项经社会经济决定因素调整的横断面研究

糖尿病困扰是一种严重的心理负担，对自我管理和临床结果产生不利影响。粮食不安全被认为是造成这种痛苦的一个因素。本研究旨在研究经社会经济因素调整后的2型糖尿病患者的食物不安全与糖尿病困扰之间的关系。方法在这项横断面研究中，通过方便抽样，于2025年在伊朗Qazvin门诊内分泌科就诊的207例成年2型糖尿病患者入组。通过访谈者管理的问卷收集了社会经济地位、粮食不安全（使用有效的家庭获取量表）和糖尿病困扰（使用17项糖尿病困扰量表）的数据。采用多变量线性回归来确定与整体和特定领域糖尿病痛苦独立相关的因素。结果参与者平均年龄55.70（±15.95）岁，糖尿病病程7.87（±5.37）年，BMI 28.92（±4.14）kg/m²。调整协变量后，与总体糖尿病困扰程度较高相关的显著因素包括：抑郁症筛查阳性（β = 0.20, 95% CI [0.11, 0.48], p = 0.002）、农村居住（β = 0.17, 95% CI [0.08, 0.47], p = 0.006）和食品不安全（β = 0.16, 95% CI [0.05, 0.45], p = 0.016）。相反，较好的自我感知健康状况（β = -0.27, 95% CI [-0.64, -0.22], p < 0.001）和口服降糖药与胰岛素的使用（β = -0.13, 95% CI [-0.38, -0.02], p = 0.032）与较低的痛苦相关。结论：我们的研究结果表明，综合护理方法可能是有必要的，包括在糖尿病就诊期间使用有效的工具（例如PHQ-4和HFIAS）对抑郁症和食物不安全进行常规筛查，为弱势家庭提供有针对性的食物援助计划，以及旨在改善自我感知健康状况的患者教育计划，特别是在农村人口中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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