Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth Tovar

Clinical Mentor

Dr. Jo Singleton

Committee Member

Dr. Sharon Lock


A patient with diabetes is two to three times more likely to be depressed than the general population. Furthermore, the combination of diabetes and depression is associated with increased morbidity and mortality. However, research has shown that treatment for depression does not correlate with lower HbA1c levels or a decrease in morbidity and mortality. Recently, a body of evidence has shown that increased HbA1c levels and depression are associated with the emotional burden of managing diabetes. The emotional burden is caused by the constant behavioral and mental demands of managing the disease and the worry and fear of the impending disease process. When the emotional burden becomes overwhelming, it is called diabetes distress. The purpose of this project is to identify gaps in practice, disseminate knowledge, and investigate the feasibility of incorporating diabetes distress screening as a tool to assist primary care providers in treating patients with poor glycemic control. This project is a quasi-experimental study to assess knowledge, attitudes, and practices related to current treatment for patients who have difficulty meeting their glycemic goals. In addition, it includes an education intervention to introduce diabetes distress as a condition that affects adherence to lifestyle and glycemic management. Finally, it presents the Diabetes Distress Scale screening tool as a method to measure diabetes distress and monitor progress with treatment to primary care providers in the system. The results describe the current practices of primary care providers’ for evaluating and treating patients with difficulty with diabetes self-management. Secondly, a pre and post education test evaluated a change in knowledge after the education intervention. Third, attitudes about diabetes distress and intent to use the Diabetes Distress Scale in practice are described. Last, primary care providers’ feedback concerning implementation is discussed. In conclusion, the concept of diabetes distress and the use of the DDS to evaluate and monitor the condition has not been translated from research into practice. Nevertheless, primary care providers in this study are open and willing to address diabetes distress in the primary care setting but need the organization of diabetes distress-specific resources that will fit into the daily workflow and the financial constraints of the patient to allow implementation of the evidence into practice.