Psychological Distress, Glycemic Control, and Vitamin D Status in Patients with Type-2 Diabetes Mellitus from Khyber Pakhtunkhwa, Pakistan: A Cross-Sectional Study

Abstract

Background: Psychological distress is increasingly recognized as an important comorbidity in patients with type 2 diabetes mellitus (T2DM) and may adversely affect glycemic control. Emerging evidence also suggests an association between vitamin D deficiency and both metabolic dysregulation and mental health disorders; however, data from Pakistani populations remain limited.

Objective: To assess the frequency of depression, anxiety, and stress and to examine their association with glycemic control and serum vitamin D status among patients with T2DM in Khyber Pakhtunkhwa, Pakistan.

Methodology: This hospital-based cross-sectional study was conducted at the Endocrinology Department of Lady Reading Hospital, Peshawar, from December 2022 to March 2023. A total of 200 adults with T2DM aged 25–60 years were enrolled using non-probability consecutive sampling. Psychological distress was assessed using the Depression, Anxiety and Stress Scale-21 (DASS-21). Biochemical parameters included fasting blood glucose, random blood glucose, glycated hemoglobin (HbA1c), and serum 25-hydroxyvitamin D [25(OH)D] levels. Dietary vitamin D intake was evaluated using a 24-hour dietary recall. Data were analyzed using SPSS version 20. Pearson correlation and multiple linear regression analyses were applied to determine associations between psychological distress, glycemic parameters, and vitamin D levels.

Results: Participants exhibited poor glycemic control, with mean HbA1c levels of 9.59 ± 2.41% in males and 9.51 ± 1.76% in females. Mean serum vitamin D levels indicated vitamin D insufficiency in both genders (29.16 ± 5.07 ng/mL in males and 28.95 ± 4.86 ng/mL in females). Moderate to extremely severe depression, anxiety, and stress were observed in a substantial proportion of patients, with higher severity among females. HbA1c levels showed a positive association with depression and stress scores, indicating higher psychological distress with poorer glycemic control. Serum vitamin D levels demonstrated a weak inverse relationship with depression and anxiety scores, though these associations were not statistically significant.

Conclusion: Patients with T2DM demonstrated a high burden of psychological distress, suboptimal glycemic control, and vitamin D insufficiency. These findings emphasize the need for an integrated approach to diabetes management that includes routine mental health screening and nutritional assessment alongside metabolic control.