Burden of Diabetes Distress among Individuals with Diabetes and Prediabetes in Pakistan: Findings from a National Cross-Sectional Study

Background: With the rising prevalence of diabetes, its impact extends beyond physical health, significantly affecting mental well-being. Objectives: To assess the frequency of diabetes distress symptoms among individuals with diabetes and prediabetes in Pakistan Materials and Methods: A cross-sectional study was conducted across 11 cities in Pakistan from May to August 2025. Adults (aged between 18 and 75 years) diagnosed with diabetes or prediabetes were recruited through non-probability convenience sampling at community screening camps and outpatient clinics. Diabetes distress was assessed using a modified version of the International Diabetes Federation diabetes distress questionnaire. Information on sociodemographic characteristics, clinical parameters, and disease management behaviors was collected. Results: A total of 7531 individuals participated, including 55% males and 45% females. The mean age of participants in the prediabetic and diabetic groups was 52.4 ± 12.9 years and 52.8 ± 11.4 years, respectively. Among them, 81.3% of individuals living with diabetes and 77.6% of those with prediabetes reported symptoms indicative of diabetes distress. The most frequently reported symptoms included low energy (80.4%), loss of interest (74.1%), and persistent sadness (65.5%). Diabetes distress was significantly associated with female gender, older age, longer duration of diabetes, insulin use, and low treatment satisfaction ( P < 0.01). Conclusions: There is a high burden of diabetes-related psychological distress among individuals with diabetes and prediabetes in Pakistan. Addressing this distress requires proactive involvement from healthcare providers—such as routine screening for emotional well-being, empathetic communication, and timely counseling or referral—to improve both psychological health and clinical outcomes.