ORIGINAL RESEARCH article
Front. Psychol.
Sec. Health Psychology
Trajectory prediction model of diabetes distress in adults with type 2 diabetes mellitus: A 12-month prospective longitudinal study
Yu-Yun Zhang 1,2
Wei Li 3
Qing-Yan Wang 4
Fang Zhao 5
Qun Wang 6
Yu Sheng 1
1. School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, Beijing Municipality, 100006
2. School of Nursing, Kunming Medical University, Kunming, Yunnan, China
3. Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
4. School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
5. Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
6. Endocrinology and Metabolism Department, Peking University Third Hospital, Beijing, China
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Abstract
Introduction: Clarifying heterogeneous diabetes distress (DD) trajectories and their predictors from a dynamic perspective is crucial. We aimed to develop a trajectory prediction model for dynamic DD. Methods: This prospective longitudinal study included 443 adults with type 2 diabetes mellitus who completed the demographics and diabetes characteristics questionnaire, scales measuring lifestyles and psychological factors (at baseline), and the Chinese version of the Diabetes Distress Scale (at baseline and at 3-, 6-, 9-, and 12-month follow-ups). After identifying the factors associated with DD, growth mixture modeling was used to determine latent longitudinal DD trajectory classes and develop a trajectory prediction model. Results: Five DD trajectories were identified: persistently low DD (65.01%), persistently moderate DD (25.28%), persistently high DD (3.61%), decreasing DD (3.16%), and increasing DD (2.94%). Using the persistently low DD group as the reference, people with no religious belief (B=-24.932, p<.001), longer diabetes duration (B=0.042, p=.037), worse self-management behaviors (B=-0.032, p=.009), and lower self-efficacy (B=-0.287, p=.007) tended to have a persistently moderate DD trajectory. Insomnia severity (B=0.232, p=.008) and type D personality (B=2.783, p=.002) were significant positive predictors of persistently high DD trajectory. Those with higher HbA1c levels (B=0.728, p=.003) and lower self-efficacy (B=-0.858, p=.044) were more likely to belong to the decreasing DD trajectory class. Self-management behaviors (B=-0.127, p=.012) were negatively associated with belonging to the increasing DD trajectory class. Conclusion: Demographics, diabetes characteristics, lifestyles, and psychosocial factors can predict dynamic heterogeneous trajectories of DD. The trajectory prediction model will enable healthcare This is a provisional file, not the final typeset article professionals to anticipate DD trajectories and conduct targeted interventions [Trial registration: ChiCTR2100047071].
Summary
Keywords
Diabetes distress, growth mixture modeling, longitudinal study, trajectory, Type 2diabetes mellitus
Received
13 October 2024
Accepted
16 February 2026
Copyright
© 2026 Zhang, Li, Wang, Zhao, Wang and Sheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yu Sheng
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