Diabetes-related Distress and the Association to Hypertension and Cardiovascular Disease Among Individuals Living with Type 2 Diabetes in Rural areas in Vietnam

Objective The prevalence of diabetes has been rising in rural areas of Vietnam over the last years to the extend where it has become a public health burden. Individuals with diabetes-related distress (DRD) is in greater risk of adverse health outcomes e.g. lower blood sugar control and polypharmacy. The objective of this study is to assess the association between hypertension and cardiovascular disease (CVD) and the occurrence of DRD among individuals with type 2 diabetes (T2D) in rural areas of Vietnam. Method This is a cross-sectional study of 806 individuals who had been receiving treatment for T2D at a district hospital in the northern Vietnamese province Thai Binh. Based on self-reported data DRD was assessed through Problem Areas in Diabetes scale 5 (PAID5) and defined as a score of 8 or above. The occurrence of the comorbid conditions hypertension and CVD were self-reported. Results Among 806 individuals with T2D 37.7% of the men and 62.3% of the women presented with DRD. Out of the total group 35.6% reported hypertension, 7.3% reported CVD and 21.2% reported a combination of hypertension and CVD. The results of the multivariate analyses showed that the odds ratio of DRD was significantly higher (OR=1.67, CI95: 1.11-2.52) in the group who reported a combination of hypertension and CVD. Conclusion Among individuals with T2D in rural areas of Vietnam there is an increased risk of DRD if a combination of hypertension and cardiovascular disease is also present. Hence, considering diabetes-related comorbidities can be useful in order to successfully identify individuals in risk of DRD. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study is a part of the interdisciplinary research project, Living Together with Chronic Disease: Informal Support for Diabetes Management in Vietnam (VALID) (17-M09-KU), funded by the Ministry of Foreign Affairs of Denmark. The research is conducted in collaboration with the Strategic Sector Cooperation project, Strengthening the Frontline Grassroots Health Worker: Prevention and Management of NCDs at the Primary Health Care Level, carried out by the Ministries of Health of Denmark and Vietnam.The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study followed ethical guidelines developed by CIOMS (Council for International Organization of Medical Sciences). Both oral and written informed consent were obtained from all research participants and confidentiality was guaranteed. Ethical approval of the project was granted by the Ethics Committee for Biomedical Research of Thai Binh University of Medicine and Pharmacy (decision 11/2018, 23rd November 2018). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Not Applicable Additional data used for analyses in this current study are available from the corresponding author upon request.