The Silent Struggle: Diabetes Distress in South Asian Communities
Living with type 2 diabetes (T2D) is more than just managing blood sugar—it’s a daily emotional battle. For South Asians, this struggle is intensified by cultural, social, and systemic factors that contribute to a high prevalence of diabetes distress (DD). Recent research from both South Asia and immigrant communities in the United States sheds light on the magnitude of this issue and the urgent need for culturally sensitive interventions.
The DREAM Initiative study, published in [BMC Public Health. 2025 Feb 2;25(1):422] explored DD among South Asian immigrants with uncontrolled T2D in New York City. While the overall prevalence of DD was lower (15.9%), emotional burden (25.9%) and regimen-related distress (21.9%) remained significant concerns.
Key Findings
- Individuals with ≥1 day of poor mental health had 3.8 times higher odds of experiencing DD.
- Higher HbA1c levels were linked to increased regimen-related distress.
- Lower emotional support was consistently associated with higher distress across subscales.
- Immigrants from Bangladesh had significantly lower odds of DD compared to those from Guyana or Trinidad and Tobago
Gender Matters: Women Carry More Emotional Weight
Nearly 20% of women reported high diabetes distress compared to just under 12% of men. This gap may be due to:
- Women experiencing more frequent and intense psychological stress
- Greater exposure to stressful life events
- Cultural norms that discourage men from expressing vulnerability, leading to underreporting of distress
These findings highlight the need for gender-sensitive interventions that address the unique emotional challenges faced by both women and men in managing diabetes.
Social Support Makes a Difference
The same NYC study found that immigrants from Bangladesh had significantly lower odds of overall DD, emotional burden, and regimen-related distress compared to those from Indo-Caribbean countries like Guyana and Trinidad and Tobago.
Why the difference? One likely factor is social support. Bangladeshi households are often multigenerational and family-based, providing built-in emotional and practical support. This kind of community structure can act as a buffer against distress, helping individuals feel less isolated and more resilient.
Education and Access: A Critical Link
Lower education levels were strongly linked to higher emotional burden. People without a high school diploma were more likely to feel overwhelmed by their diabetes compared to those with a college degree. This isn’t just about academics—it’s about access and understanding.
- Low education often means lower health literacy, making it harder to understand treatment plans or manage diabetes effectively.
- It’s also tied to poorer health outcomes and less consistent adherence to medical advice.
- According to the 2021 American Community Survey, adults in NYC without a high school diploma were more likely to be uninsured, limiting their ability to consult doctors or afford medications.
- These barriers—combined with acculturative stress, discrimination, and financial hardship—can make diabetes management even more difficult for South Asian immigrants.
The Need for Culturally Valid Tools
One major gap in current research is the lack of concept validation for tools like the Diabetes Distress Scale (DDS) in diverse cultural groups. Without ensuring that these tools truly reflect the lived experiences of South Asian populations, we risk misrepresenting or underestimating distress.
- Cultural validity is essential to accurately measure emotional burden and distress.
- Future research should prioritize concept validation before scale validation to ensure relevance and accuracy.
- This is especially important when designing interventions or policies aimed at improving diabetes care in multicultural settings.
A Call to Action for Health Leaders
DD isn’t just a side effect—it’s a clinical issue that affects treatment outcomes. For South Asian patients, especially women and those with limited support systems or education, screening for DD should be standard practice.
Improving Outcomes Through Clinical and Policy Action
• Use culturally validated tools to assess distress
• Screen for DD in both diabetes and prediabetes patients
• Integrate mental health services into routine diabetes care
• Encourage family involvement and community support
Final Thought
Diabetes distress is a silent epidemic in South Asian communities. With nearly half of patients affected in South Asia and significant emotional burden among immigrants, clinicians and researchers must act. By recognizing DD, validating culturally relevant tools, and integrating care models that address both mental and physical health, we can build a more equitable and effective diabetes care system.
References
Mohsin F, Wyatt L, Belli H, Ali S, Onakomaiya D, Misra S,
Yusuf Y, Mammen S, Zanowiak J, Hussain S, Zafar H, Lim S, Islam N, Ahmed N.
Diabetes distress among immigrants of south Asian descent living in New York
City: baseline results from the DREAM randomized control trial. BMC Public
Health. 2025 Feb 2;25(1):422. doi: 10.1186/s12889-025-21535-8.
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