Lack of Association of Emotional Distress With Insulin Initiation in the GRADE Randomized Diabetes Comparative Effectiveness Trial.
Caroline A Presley, Nicole M Butera, Heidi Krause-Steinrauf and 9 others
PMID 40751289WHAT IT FOUND
Depressive symptoms and diabetes distress showed no clear association with starting basal or rapid-acting insulin when A1C reached the trial's insulin intensification thresholds.
In analyzed samples, 178 of 525 never started basal insulin, and 106 of 325 started rapid-acting insulin.
Key findings
01Total depressive symptom scores and total diabetes distress scores were not significantly associated with timing of basal insulin initiation.
02Total depressive symptom scores and total diabetes distress scores were not significantly associated with initiating rapid-acting insulin.
03Among participants analyzed for basal insulin, 178 of 525 never initiated basal insulin; among participants analyzed for rapid-acting insulin, 106 of 325 initiated rapid-acting insulin.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis included only participants who completed emotional distress questionnaires within 12 months before the glycemic outcome confirmation, so some trial participants were excluded. Participants were in a clinical trial, had agreed at baseline to start insulin if needed, received regular assessments and free study medications, so their experience may differ from routine care. The emotional distress substudy sample had lower baseline depressive symptoms and diabetes distress than some other diabetes populations, limiting generalizability. Because of sample size, models could not adjust for all relevant covariates, such as medication adherence. For non-glargine participants reaching the tertiary outcome, stopping randomized study medication when rapid-acting insulin was added may have influenced decisions. Participants were enrolled between 2015 and 2017, and current treatment options may differ.
Declared interests
The supplied text does not report author conflicts of interest. The publication metadata indicates NIH extramural research support.
The easy way to misread this
Do not conclude that emotional distress has no role in insulin initiation outside trial settings. Participants had already agreed to take injectable medications, received study medications at no cost, had regular follow-up, and had lower baseline depressive symptoms and diabetes distress than in some other diabetes populations, so routine-care barriers may differ.