The Examination and Exploration of Diabetes Distress in Pre-existing Diabetes in Pregnancy: A Mixed-methods Study

BACKGROUND Diabetes distress has been understudied in the pregnancy population. Pregnancy is known to be a complex, highly stressful time for women with diabetes because of medical risks and the high burden of diabetes management. OBJECTIVE This study aimed to explain and understand diabetes distress in women with pre-existing diabetes in pregnancy. METHODS An explanatory, sequential mixed methods study was undertaken. The first strand consisted of a cross-sectional study of 76 women with type 1 and type 2 diabetes. A nested sampling approach was used to re-recruit 18 women back into the second strand for qualitative interviews using an interpretive description approach. RESULTS Diabetes distress was measured by the validated PAID scale. A PAID score of 40 or higher indicates positive distress. Diabetes distress prevalence was 22.4% in the cross-sectional cohort and the average PAID score was 27.75 (SD 16.08). In the qualitative strand, women with a range of PAID scores (10.0 – 60.0) were sampled for interviews. The majority of these participants described themes of diabetes distress in their interviews. Of the 15 women who described diabetes distress thematically, only 6 had positive PAID scores. DISCUSSION Integration of the mixed methods data underscores important meta-inferences about diabetes distress in pregnancy, namely that diabetes distress was present to a greater degree than the PAID tool is sensitive to. Diabetes distress was present qualitatively in most of the qualitative sample, despite interviewing women with a range of PAID scores. Future research on a pregnancy-specific diabetes distress scale is needed.