{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T18:07:45Z","timestamp":1789150065516,"version":"build-2803163510"},"reference-count":34,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Diabetes distress is a key mental health dimension of type 2 diabetes (T2D) and a growing concern as populations age, yet its determinants in older adults remain insufficiently characterized. The independent contributions of demographic and metabolic factors to severe distress and their implications for multidisciplinary screening across the lifespan remain unclear. Methods: In this cross-sectional study, we assessed 453 adults with T2D using the 17-item Diabetes Distress Scale (DDS-17). We categorized participants as experiencing low (&lt;2), moderate (2\u20132.9), or severe (\u22653) distress. We compared categories using the Kruskal\u2013Wallis H test and chi-square tests. Logistic regression models were constructed with severe distress (DDS \u2265 3) as the outcome, adjusting for sex, educational level, and HbA1c. Results: Severe distress was identified in 19 participants (4.2%). Age differed significantly across DDS categories (Kruskal\u2013Wallis H test, p = 0.003), with the severe group being significantly older (72.95 \u00b1 4.38 years). Emotional burden was the dominant subscale across all groups. In multivariable logistic regression, increasing age (aOR = 1.163 per year; 95% CI: 1.055\u20131.282; p = 0.002) and lower educational level (high school vs. basic: aOR = 0.187; p = 0.020) were independently associated with severe distress, whereas metabolic variables were not independently associated with severe distress. ROC analysis identified age \u2265 70 years as an exploratory, sample-derived cut-off (AUC = 0.726, 95% CI 0.602\u20130.827; sensitivity 84%, specificity 55%). Results were robust in sensitivity analyses that excluded patients with diabetes duration &lt; 5 years. Conclusions: Severe diabetes distress is more strongly associated with demographic vulnerability than with metabolic burden. Age \u2265 70 years and lower educational attainment may help identify older adults at increased risk of diabetes-related distress, supporting targeted psychological screening strategies in this lifespan stage.<\/jats:p>","DOI":"10.3390\/diseases14090332","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:14:59Z","timestamp":1789146899000},"page":"332","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Demographic Vulnerability and Mental Health in Older Adults with Type 2 Diabetes: A Lifespan-Informed Analysis of Diabetes Distress"],"prefix":"10.3390","volume":"14","author":[{"given":"Adriana","family":"Gherbon","sequence":"first","affiliation":[{"name":"Department VII Internal Medicine\u2014Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Center of Molecular Research in Nephrology and Vascular Disease, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Diabetes, Nutrition, and Metabolic Diseases, \u201cPius Br\u00eenzeu\u201d Emergency Hospital, 300723 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6281-6652","authenticated-orcid":false,"given":"Deiana","family":"Roman","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Railway Clinical Hospital, 300173 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6288-3695","authenticated-orcid":false,"given":"Marioara","family":"Nicula-Neagu","sequence":"additional","affiliation":[{"name":"Faculty of Bioengineering of Animal Resources, Discipline of Physiology, University of Life Sciences \u201cKing Mihai I\u201d, 300645 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5249-6859","authenticated-orcid":false,"given":"Mirela","family":"Frandes","sequence":"additional","affiliation":[{"name":"Department III of Functional Sciences\u2014Biostatistics and Medical Informatics, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"Sun","year":"2022","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_2","unstructured":"GBD 2021 Diabetes Collaborators (2023). Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: A systematic analysis for the Global Burden of Disease Study 2021. Lancet, 402, 203\u2013234."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"626","DOI":"10.2337\/diacare.28.3.626","article-title":"Assessing psychosocial distress in diabetes: Development of the Diabetes Distress Scale","volume":"28","author":"Polonsky","year":"2005","journal-title":"Diabetes Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"542","DOI":"10.2337\/dc06-1614","article-title":"Clinical depression versus distress among patients with type 2 diabetes: Not just a question of semantics","volume":"30","author":"Fisher","year":"2007","journal-title":"Diabetes Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"236","DOI":"10.2337\/dc10-1970","article-title":"Depression in diabetes: Have we been missing something important?","volume":"34","author":"Gonzalez","year":"2011","journal-title":"Diabetes Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1370\/afm.842","article-title":"Development of a brief diabetes distress screening instrument","volume":"6","author":"Fisher","year":"2008","journal-title":"Ann. Fam. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"23","DOI":"10.2337\/dc09-1238","article-title":"Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses","volume":"33","author":"Fisher","year":"2010","journal-title":"Diabetes Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.2337\/dc09-2175","article-title":"The relationship between diabetes distress and clinical depression with glycemic control among patients with type 2 diabetes","volume":"33","author":"Fisher","year":"2010","journal-title":"Diabetes Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1111\/dme.13448","article-title":"The prevalence of diabetes-specific emotional distress in people with type 2 diabetes: A systematic review and meta-analysis","volume":"34","author":"Perrin","year":"2017","journal-title":"Diabet. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1373\/clinchem.2010.148841","article-title":"Status of hemoglobin A1c measurement and goals for improvement: From chaos to order for improving diabetes care","volume":"57","author":"Little","year":"2011","journal-title":"Clin. Chem."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee (2024). 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes\u20142024. Diabetes Care, 47, S20\u2013S42.","DOI":"10.2337\/dc24-S002"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3021","DOI":"10.1093\/eurheartj\/ehy339","article-title":"2018 ESC\/ESH Guidelines for the management of arterial hypertension","volume":"39","author":"Williams","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1111\/j.1464-5491.2005.01414.x","article-title":"Affective and anxiety disorders in a German sample of diabetic patients: Prevalence, comorbidity and risk factors","volume":"22","author":"Hermanns","year":"2005","journal-title":"Diabet. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"259","DOI":"10.2337\/dc11-1572","article-title":"When is diabetes distress clinically meaningful? Establishing cut points for the Diabetes Distress Scale","volume":"35","author":"Fisher","year":"2012","journal-title":"Diabetes Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1007\/s10865-019-00106-4","article-title":"Diabetes stress and health: Is aging a strength or a vulnerability?","volume":"43","author":"Helgeson","year":"2020","journal-title":"J. Behav. Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Batais, M.A., Alfraiji, A.F., Alyahya, A.A., Aloofi, O.A., Almashouq, M.K., Alshehri, K.S., Almizel, A.M., Alotaibi, M.T., and Alosaimi, F.D. (2021). Assessing the prevalence of diabetes distress and determining its psychosocial predictors among Saudi adults with type 2 diabetes: A cross-sectional study. Front. Psychol., 12.","DOI":"10.3389\/fpsyg.2021.759454"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"7328128","DOI":"10.1155\/2018\/7328128","article-title":"Diabetes-related distress assessment among type 2 diabetes patients","volume":"2018","author":"Aljuaid","year":"2018","journal-title":"J. Diabetes Res."},{"key":"ref_18","first-page":"750","article-title":"Understanding the areas and correlates of diabetes-related distress in adults with type 1 diabetes","volume":"41","author":"Hessler","year":"2016","journal-title":"J. Diabetes Complicat."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Chew, B.H., Mohd-Sidik, S., and Shariff-Ghazali, S. (2016). Diabetes-related distress, depression and distress-depression among adults with type 2 diabetes mellitus in Malaysia. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0152095"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kamrul-Hasan, A.B.M., Hannan, M.A., Asaduzzaman, M., Rahman, M.M., Alam, M.S., Amin, M.N., Kabir, M.R., Chanda, P.K., Jannat, N., and Selim, S. (2022). Prevalence and predictors of diabetes distress among adults with type 2 diabetes mellitus: A facility-based cross-sectional study of Bangladesh. BMC Endocr. Disord., 22.","DOI":"10.1186\/s12902-022-00938-3"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/jan.15483","article-title":"Resilience, self-efficacy and diabetes distress on self-management behaviours in patients newly diagnosed with type 2 diabetes: A moderated mediation analysis","volume":"79","author":"Wang","year":"2023","journal-title":"J. Adv. Nurs."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.jcjd.2018.11.002","article-title":"Association of depressive symptoms and diabetes distress with severe hypoglycemia in adults with type 2 diabetes","volume":"43","author":"AlSayah","year":"2019","journal-title":"Can. J. Diabetes"},{"key":"ref_23","first-page":"109352","article-title":"Prevalence of diabetes distress among people with type 2 diabetes in South Asia: A systematic review and meta-analysis","volume":"16","author":"Pappachan","year":"2025","journal-title":"World J. Diabetes"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1111\/dme.12887","article-title":"How to assess diabetes distress: Comparison of the Problem Areas in Diabetes Scale (PAID) and the Diabetes Distress Scale (DDS)","volume":"33","author":"Schmitt","year":"2016","journal-title":"Diabet. Med."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Bubulac, L., Dobjanschi, C.G., Zivari, M., Erena, C., Tudor, V., and Albu, C.-C. (2026). Psychological Distress and Health-Related Quality of Life in Romanian Adults with Diabetes Mellitus: A Cross-Sectional Study. Healthcare, 14.","DOI":"10.3390\/healthcare14020158"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1111\/dme.13967","article-title":"Addressing diabetes distress in clinical care: A practical guide","volume":"36","author":"Fisher","year":"2019","journal-title":"Diabet. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/S2213-8587(15)00135-7","article-title":"Constructs of depression and distress in diabetes: Time for an appraisal","volume":"3","author":"Snoek","year":"2015","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.dsx.2017.12.024","article-title":"Prevalence and determinants of diabetes distress in patients of diabetes mellitus in a tertiary care centre","volume":"12","author":"Gahlan","year":"2018","journal-title":"Diabetes Metab. Syndr. Clin. Res. Rev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1007\/s11606-019-04832-y","article-title":"The role of health literacy in diabetes knowledge, self-care, and glycemic control: A meta-analysis","volume":"34","author":"Marciano","year":"2019","journal-title":"J. Gen. Intern. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"276","DOI":"10.2337\/dsi22-0006","article-title":"Equity in psychosocial outcomes and care for racial and ethnic minorities and socioeconomically disadvantaged people with diabetes","volume":"35","author":"Butler","year":"2022","journal-title":"Diabetes Spectr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"617","DOI":"10.2337\/dc13-0762","article-title":"Reductions in regimen distress are associated with improved management and glycemic control over time","volume":"37","author":"Hessler","year":"2014","journal-title":"Diabetes Care"},{"key":"ref_32","first-page":"CD011469","article-title":"Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus","volume":"9","author":"Chew","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1177\/1744987120943936","article-title":"Predictors of diabetes distress among older persons with type 2 diabetes mellitus in Indonesia","volume":"26","author":"Asshiddiqi","year":"2021","journal-title":"J. Res. Nurs."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.2147\/DMSO.S304904","article-title":"The Mental Status in Patients with Diabetes Mellitus Admitted to a Diabetes Clinic After Presenting in the Emergency Room: The Application of the SCL-90 Scale","volume":"14","author":"Albai","year":"2021","journal-title":"Diabetes Metab. Syndr. Obes."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/9\/332\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:24:35Z","timestamp":1789147475000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/9\/332"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,11]]},"references-count":34,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diseases14090332"],"URL":"https:\/\/doi.org\/10.3390\/diseases14090332","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,11]]}}}