{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:17:01Z","timestamp":1788153421279,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["113\u20102314\u2010B\u2010038\u2010055\u2010MY3"],"award-info":[{"award-number":["113\u20102314\u2010B\u2010038\u2010055\u2010MY3"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["sigmapubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Worldviews Ev Based Nurs"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetes\u2010related quality of life (DR\u2010QoL) is shaped by interactions between cardiometabolic dysfunction and psychological stress, yet these mechanisms are rarely examined within a unified framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To evaluate the independent, interactive, and mediating effects of cardiometabolic factors and stress on DR\u2010QoL obstacles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross\u2010sectional study was conducted among 1815 adults with type 2 diabetes from 15 Indonesian provinces (2023\u20132024). Stress and DR\u2010QoL obstacles were assessed using validated instruments. Independent and synergistic effects were examined using logistic regression, and mediation was tested via path analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overweight, obesity, stage 2 systolic hypertension, and abnormal fasting blood glucose (FBG) significantly predicted high stress (AOR\u2009=\u20091.982\u201320.889;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), with synergistic interactions markedly amplifying the risk (AOR up to 53.972). DR\u2010QoL obstacles were strongly associated with cardiometabolic abnormalities (AOR\u2009=\u20091.352\u201318.420) and high stress (AOR\u2009=\u200918.930), with the highest risk observed in participants with multiple concurrent abnormalities (AOR\u2009=\u200952.097). Mediation analysis identified FBG and stress as key mediators, with stress showing the strongest direct effect on DR\u2010QoL obstacles (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.397).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Linking Evidence to Action<\/jats:title>\n                    <jats:p>These findings highlight FBG and stress as central mechanistic targets for interventions aimed at reducing DR\u2010QoL obstacles.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/wvn.70168","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T04:58:43Z","timestamp":1785128323000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants of Stress and Obstacles to Diabetes\u2010Related Quality of Life in Adults With Type 2 Diabetes: A Cross\u2010Sectional Interaction\u2013Mediation Analysis"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3336-3276","authenticated-orcid":false,"given":"Siti","family":"Fadlilah","sequence":"first","affiliation":[{"name":"School of Nursing, College of Nursing Taipei Medical University  Taipei Taiwan"},{"name":"Program Study of Nursing Universitas Respati Yogyakarta  Yogyakarta Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5456-9177","authenticated-orcid":false,"given":"Santi","family":"Damayanti","sequence":"additional","affiliation":[{"name":"Program Study of Nursing Universitas Respati Yogyakarta  Yogyakarta Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6460-838X","authenticated-orcid":false,"given":"Maria Dyah","family":"Kurniasari","sequence":"additional","affiliation":[{"name":"Undergraduate Nursing Program, Faculty of Health Sciences Universitas Kristen Satya Wacana  Salatiga Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9113-516X","authenticated-orcid":false,"given":"Shih Hsin","family":"Hsiao","sequence":"additional","affiliation":[{"name":"School of Respiratory Therapy, College of Medicine Taipei Medical University  Taipei Taiwan"},{"name":"Division of Pulmonary Medicine, Department of Internal Medicine Taipei Medical University Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9597-1413","authenticated-orcid":false,"given":"Lee Kai","family":"Ling","sequence":"additional","affiliation":[{"name":"School of Respiratory Therapy, College of Medicine Taipei Medical University  Taipei Taiwan"},{"name":"Division of Pulmonary Medicine, Department of Internal Medicine Taipei Medical University Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3569-3746","authenticated-orcid":false,"given":"Po Hao","family":"Feng","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine, Department of Internal Medicine Shuang\u2010Ho Hospital, Taipei Medical University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1708-7301","authenticated-orcid":false,"given":"Hazel Novela","family":"Villagracia","sequence":"additional","affiliation":[{"name":"Medical Surgical Department, College of Nursing University of Ha'il  Ha'il Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1137-9274","authenticated-orcid":false,"given":"Hsiu Ting","family":"Tsai","sequence":"additional","affiliation":[{"name":"School of Nursing, College of Nursing Taipei Medical University  Taipei Taiwan"},{"name":"Center of Excellence for Enhancing Well\u2010Being in Vulnerable and Chronic Illness Populations, Faculty of Nursing Chulalongkorn University  Bangkok Thailand"},{"name":"Post\u2010Baccalaureate Program in Nursing, College of Nursing Taipei Medical University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,26]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1282249"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13154389"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph21101275"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13104\u2010025\u201007238\u20108"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1289689"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare12030352"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102021\u2010056304"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms252413294"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/nop2.70486"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/JNR.0000000000000704"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/abm\/kaae056"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc09\u20101238"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2025.1629825"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2017.64"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci20\u20100053"},{"key":"e_1_2_11_17_1","unstructured":"International Diabetes Federation.2025.\u201cIDF Diabetes Atlas 11th Edition.\u201dhttps:\/\/www.diabetesatlas.org."},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13098\u2010024\u201001391\u2010z"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.2196\/39750"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1155\/2024\/3946553"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12245"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12902\u2010024\u201001784\u20101"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/13814788.2021.1954615"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12887"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0289502"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1590\/1518\u20108345.6827.4073"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0140599"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2025.1622988"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/23779608231185921"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2025.112014"}],"container-title":["Worldviews on Evidence-Based Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/sigmapubs.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/wvn.70168","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/sigmapubs.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/wvn.70168","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/sigmapubs.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/wvn.70168","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T04:25:16Z","timestamp":1788150316000},"score":1,"resource":{"primary":{"URL":"https:\/\/sigmapubs.onlinelibrary.wiley.com\/doi\/10.1111\/wvn.70168"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,26]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/wvn.70168"],"URL":"https:\/\/doi.org\/10.1111\/wvn.70168","archive":["Portico"],"relation":{},"ISSN":["1545-102X","1741-6787"],"issn-type":[{"value":"1545-102X","type":"print"},{"value":"1741-6787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,26]]},"assertion":[{"value":"2025-12-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70168"}}