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Observational Study
. 2025 Feb 24;13(1):e004524.
doi: 10.1136/bmjdrc-2024-004524.

Clinical phenotyping of people living with type 1 diabetes according to their levels of diabetes-related distress: results from the SFDT1 cohort

Dulce Canha  1   2 , Gloria Aguayo  1 , Emmanuel Cosson  3   4 , Patricia Vaduva  5 , Eric Renard  6   7 , Fawaz Alzaid  8   9 , Fabrice Bonnet  10 , Samy Hadjadj  11 , Louis Potier  8   12 , Bruno Vergès  13 , Sandrine Lablanche  14 , Pierre Yves Benhamou  15 , Helene Hanaire  16 , Yves Reznik  17 , Jean-Pierre Riveline  8   18 , Guy Fagherazzi  19
Affiliations
Observational Study

Clinical phenotyping of people living with type 1 diabetes according to their levels of diabetes-related distress: results from the SFDT1 cohort

Dulce Canha et al. BMJ Open Diabetes Res Care. .

Abstract

Introduction: Type 1 diabetes is burdensome, requiring complex daily management and making people more prone to emotional distress. To better detect diabetes-related distress (DD) and identify at-risk patients, we aimed to provide an in-depth characterization of DD in people with type 1 diabetes.

Research design and methods: We included adults with type 1 diabetes from the Suivi en France des personnes avec un Diabète de Type 1 cohort who filled in the Problem Areas in Diabetes questionnaire (PAID ≥40 indicates high DD). Age and sex-adjusted multivariable logistic regression models analyzed individual characteristics, clinical indicators, diabetes-related complications and psychological factors. We further analyzed DD according to six data-driven subdimensions: emotional distress, fear of complications, social distress, eating distress, management distress, and diabetes burnout.

Results: In total, 1220 participants (50.6% female, age 42 years (SD 13.9), diabetes duration 24.7 years (13.6)) had a total mean PAID score of 39.6 (21.7) and 592 (48.5%) reported high DD. Leading subdimensions of DD included fear of complications (50.1 (24.4)) and diabetes burnout (45.9 (24.5)). Females, younger age, social vulnerability, smoking, and the presence of retinopathy were positively associated with high DD (p<0.05). We observed similar DD levels across HbA1c levels and treatment modalities, including automated insulin delivery and continuous glucose monitoring use. Several psychological factors, such as anxiety/depression, poor sleep quality, and treatment burden, were strongly associated with DD (p<0.001).

Conclusions: We provide a holistic clinical phenotyping approach that enables the identification of determinants and prevalence of DD, overall and according to key DD subdimensions, in a large and diverse population. Our results underscore the importance of developing DD-targeted prevention and intervention strategies focused specifically on high-risk groups and the most impactful distress subdimensions to reduce the impact of type 1 diabetes burden.

Trial registration number: NCT04657783.

Keywords: Adult; Diabetes Mellitus, Type 1; Phenotype; Psychology.

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Conflict of interest statement

Competing interests: PV has received a grant from IPSEN for fundamental scientific work and personal honoraria for lectures and/or meeting attendance from Lilly, Sanofi and Urgo, outside the field of this article. SH reports receiving grants from Asdia, Asten, AstraZeneca, Homeperf, ISIS Diabete, LVL, Nestle Home Care, Pierre Fabre, and VitalAire; consulting fees from AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Sanofi, Servier, and Valbiotis; speaking fees from Abbott, AstraZeneca, Boehringer Ingelheim, Bayer, Dino Santé, Eli Lilly, Novartis, Novo Nordisk, Pierre Fabre, Sanofi, Servier, and Valbiotis; and meeting invitations from AstraZeneca, Abbott, Dino Santé, Eli Lilly, and Novo Nordisk. LP reports receiving consulting fees from AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Sanofi and Servier; speaking fees from AstraZeneca, Boehringer Ingelheim, Bayer, Eli Lilly, Novo Nordisk, and Sanofi; and meeting invitations from Eli Lilly, Sanofi and Novo Nordisk. SL has received speaker honoraria from Abbott, Novo Nordisk, Sanofi, Eli Lilly and Company, and Insulet, and has served on advisory board panels for Diabeloop and Medtronic. PYB has received speaker honoraria from Abbott, Eli Lilly, Novo Nordisk and Sanofi; is the chief medical officer for Diabeloop; and served on advisory board panels for Abbott, Dexcom, Insulet, LifeScan, Eli Lilly, Novo Nordisk and Sanofi. HH has performed clinical trials for and/or has provided advisory/speaking services for and/or has received research grants from Abbott, Air Liquide Healthcare, AstraZeneca, Insulet Isis, LifeScan, Lilly, Medtronic, MSD, Novo Nordisk, Sanofi and Vitalaire. J-PR is an advisory panel member for Sanofi, MSD, Eli Lilly, Novo Nordisk, AstraZeneca, Abbott, Dexcom, Alphadiab, Air Liquide Healthcare and Medtronic and has received research funding from and provided research support to Abbott, Air Liquide Healthcare, Sanofi and Novo Nordisk. GF has provided advisory/speaking services for and/or has received research grants and/or speaker honoraria from MSD, MSDAvenir, Eli Lilly, Roche Diabetes Care, AstraZeneca, Danone Research, Diabeloop, Bristol Myers Squibb, L’Oréal R&D, AbbVie Pharmaceutical, Pfizer, Vitalaire and Akuity Care.

Figures

Figure 1
Figure 1. Problem Areas in Diabetes (PAID) characteristics in Suivi en France des personnes avec un Diabète de Type 1 (SFDT1). (a) Comparison of PAID scores by diabetes distress subdimensions. (b) Top five (ie, higher mean) PAID items. (c) Comparison of total PAID scores by age and sex. (d) Comparison of PAID scores across insulin treatment modalities. (c and d) Dashed lines at y=40 indicate threshold for high diabetes distress. AID, automated insulin delivery; MDI, multiple daily injections.
Figure 2
Figure 2. Clinical phenotyping of Suivi en France des personnes avec un Diabète de Type 1 (SFDT1) cohort participants: significant associations (p<0.05) between study variables and moderate (circle) and high (triangle) diabetes distress levels (reference: low). Red: positive association (OR>1). Blue: negative association (OR<1). The lines represent ORs and 95% CIs from age and sex-adjusted multivariable logistic regression models. Age and sex variables are adjusted for each other. DD, diabetes-related distress; QoL, quality of life.
See this image and copyright information in PMC

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