Diabetes distress as mediators of loneliness and health promotion behaviour: a cross-sectional study

Objectives The purpose of this study was to explore whether diabetes distress mediated the relationship between loneliness and health promotion in older adults with diabetes.Design A cross-sectional study.Setting The study was conducted at three tertiary hospitals in Changsha, Hunan Province, China.Participants The sample included 140 patients with diabetes (65 years and older, mean age 72.6 years, SD=4.6).Methods We employed path models to analyse data on diabetes distress, loneliness and health promotion behaviours. We collected diabetes distress, loneliness and health promotion behaviour with self-reported questionnaires including the Diabetes Distress Scale, the University of California at Los Angeles (UCLA) Loneliness Scale and the Elderly Health Promotion Scale from January 2022 to October 2022. Mediation analysis was performed by SPSS V.26.0's PROCESS macro.Result The findings of this study indicated diabetes distress acted as a mediator between loneliness and health promotion behaviour. According to bootstrapping results, the total effect of loneliness on health promotion behaviour was significantly negative (beta=-0.312, p=0.006). Loneliness significantly and negatively correlated with diabetes distress (beta=-0.043, p<0.001), while diabetes distress significantly and negatively correlated with health promotion behaviours (beta=-2.724, p=0.008). Both the indirect effect and the direct effect of loneliness on health promotion behaviour were significant.Conclusion Our study illustrated that loneliness was negatively associated with health promotion behaviours, and diabetes distress acted as a mediator in this relationship. It is suggested that healthcare providers should prioritise the identification and management of diabetes distress in older patients with diabetes who experience loneliness to improve health promotion behaviours and optimise disease management outcomes.