الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
Rising geriatric population is a major concern to health economists due to increase health care services budgets and costs that are directed toward them and living with chronic illnesses such as diabetes for many more years. DM is a group of chronic metabolic disorders characterized by abnormalities in insulin secretion, action or both. The resulting hyperglycemia is associated with disordered carbohydrate, fat and protein metabolism and can lead to long-term organ dysfunction. It remains a serious cause of morbidity and mortality. Worldwide, The International Diabetes Federation (IDF) estimates around 415 million people (8.8%) had DM in 2015 and this number is expected to rise to 642 million (10.4%) by 2040. In United States (US), 29.3 million (11%) of the population have diabetes. Additionally, an estimated 35.8 million (13.4%) have impaired glucose tolerance (IGT) and are classified as pre-diabetics. In Egypt, the prevalence of type 2 diabetes mellitus is around 15.6% of all adults aged 20 to 79 years and around 32.4% of elderly population aged above 60 years.
People with type 2 DM suffer from complications such as cardiovascular disease, nephropathy, retinopathy and neuropathy because of suboptimal control of blood glucose, blood pressure and lipids. DM affects not only individual’s physical health, but also his mental wellbeing as upon diagnosis, he acquires added responsibilities, planning and self-monitoring to manage DM and reach the desired targeted glycemic control. Recent systematic reviews have shown depression to be 2–3 times more common in individuals with diabetes than in people without diabetes.
Diabetes Distress (DD) is the negative psychological reaction related to emotional burdens and worries specific of having to manage a severe, complicated and demanding chronic disease such as diabetes. The constant behavioral demands (medication dosing, frequency, titration, blood glucose monitoring, food intake, eating patterns and physical activity) of diabetes self- management, progression and complications are directly associated with DD. DD is directly proportionate to diabetes duration which could be explained by progressive increase of micro-vascular complication and insulin treatment. The odds of having DD are higher for being female, previously having depression, experiencing more negative events or more chronic stress, having more complications, and having poor diet and low exercise. It was found that high levels of DD are associated with higher levels of HbA1c due to lower self-efficiency, poorer dietary and exercise behavior and non-compliance to the treatment. ADA guidelines suggests that DD should be routinely monitored, assessed and managed if present.
DD has 4 domains: emotional, physician, regimen and interpersonal distress. Screening for DD is by DDS17 questionnaire with considering the patient to have DD if his score is ≥ 2.
Although it’s common to overlap DD with Depression, there are many differences between them. Depression is one of the few diagnoses in medicine defined exclusively by symptoms not by cause or disease process. It requires presence of well- defined diverse symptoms (5/9 on DSM-V). When the structured clinical interview (the standard for depression diagnosis) is used, no relationship is found between it, diabetes, diabetes self-management or DD.
The aim of the study was to detect prevalence of DD among elderly Egyptian diabetic patients. This was a descriptive cross-sectional study conducted on a total of 100 elderly Egyptian diabetic patients who presented in inpatient wards and outpatient clinics.
All participants were subjected to Comprehensive geriatric assessment, DDS17 questionnaire and HbA1c testing.
The study found that the prevalence of total DD among the studied cases was 37% which appeared to be in the average range of the global parentage. The most affected domain was regimen distress (54%) followed by emotional distress (28%) then physician distress (26%) and lastly interpersonal distress (25%). There was highly statistically significant relationship between total DD and different DD domains. This means that having total DD or other DD domain is usually associated with having other DD domains. The possibility of having DD increased significantly with the following risk factors; being female, obesity, non-married, longer diabetic duration, longer hypertension duration, using insulin, having diabetic complications and untreated cataract. Patients having these risk factors are advised to be screened for DD especially if their diabetic state is uncontrolled.
The study found a statistically significant relation between total DD or other DD domains and mean HbA1c. Having DD was associated with poor glycemic control.
So, if the patients have DD, identifying the affected domain and proper implantation of appropriate measures to correct the affected domain would help to improve their glycemic state.