Diabetes distress is associated with food insecurity in Iranian adults with type 2 diabetes: a cross sectional study adjusted for socioeconomic determinants

Introduction Diabetes distress represents a significant psychological burden that adversely affects self-management and clinical outcomes. Food insecurity has been proposed as factor associated with this distress. This study aimed to examine the association between food insecurity and diabetes distress in individuals with type 2 diabetes adjusted for socioeconomic factors. Methods In this cross-sectional study, 207 adult patients with type 2 diabetes attending outpatient endocrinology clinics in Qazvin, Iran, were enrolled during 2025 via convenience sampling. Data on socioeconomic status, food insecurity (using a validated household access scale), and diabetes distress (using the 17-item Diabetes Distress Scale) were collected through interviewer-administered questionnaires. Multivariable linear regression was employed to identify factors independently associated with overall and domain-specific diabetes distress. Results Participants had a mean age of 55.70 (±15.95) years, diabetes duration of 7.87 (± 5.37) years, and a BMI of 28.92 (± 4.14) kg/m². After adjustment for covariates, significant factors associated with greater overall diabetes distress included: positive screen for depression (β = 0.20, 95% CI [0.11, 0.48], p = 0.002), rural residence (β = 0.17, 95% CI [0.08, 0.47], p = 0.006), and food insecurity (β = 0.16, 95% CI [0.05, 0.45], p = 0.016). Conversely, better self-perceived health status (β = -0.27, 95% CI [-0.64, -0.22], p < 0.001) and use of oral hypoglycemic agents versus insulin (β = -0.13, 95% CI [-0.38, -0.02], p = 0.032) were associated with lower distress. Conclusion Our findings suggest that integrated care approaches may be warranted including routine screening for depression and food insecurity using validated tools (e.g., PHQ-4 and HFIAS) during diabetes visits, targeted food assistance programs for vulnerable households, and patient education programs designed to improve self-perceived health status, particularly in rural populations.