Emotional Distress is Associated with Lower Health-Related Quality of Life Among Patients with Diabetes Using Antihypertensive and/or Antihyperlipidemic Medications: A Multicenter Study in Indonesia

Objective: To evaluate the associations between different types of diabetes distress and health-related quality of life (HRQOL) among patients with type 2 diabetes (T2DM) using antihypertensive and/or antihyperlipidemic medications in Indonesia and to explore the differences between those using only antihypertensive, only antihyperlipidemic, or both medications. Methods: A multicenter cross-sectional study was conducted in Community Health Centers in three cities in Indonesia among patients with T2DM aged at least 18 years who were using antihypertensive and/or antihyperlipidemic medications. Diabetes distress subscales (emotional, regimen-related, interpersonal, and physician-related distress) and HRQOL were assessed using a validated diabetes distress scale-17 and EQ-5D-5L scale, respectively. Multiple linear regression models were used to evaluate the associations between different types of diabetes distress and HRQOL adjusting for confounders. Results: Most of the 503 participants were females (67.6%) and aged 60-69 years (40.8%). Emotional distress was negatively associated with HRQOL among the whole group of patients (13: -0.08; 95% confidence interval (CI): -0.10, -0.05; p < 0.001). This association was similar across all therapeutic subgroups. Regimen-related distress (13: -0.06; 95% CI: -0.09, -0.03; p < 0.001) and interpersonal distress (13: -0.02; 95% CI: -0.05, -0.01; p = 0.022) were negatively associated, whereas physician-related distress (13: 0.04; 95% CI: 0.01, 0.07; p = 0.037) was positively associated with HRQOL among the whole group. These associations were also observed among those using only antihypertensive medication. Conclusion: Emotional distress affects HRQOL in T2DM patients treated for cardiovascular comorbidities, independent of antihypertensive and/or antihyperlipidemic medication use.