This case-control study among patients with type 2 diabetes and a control group of participants without diabetes demonstrated that diabetic patients particularly those with psychological problems had a significantly higher prevalence of psychosomatic symptoms and total score of psychosomatic symptom profiles than controls. We found that the scores of psycho-fatigue, gastrointestinal, neuro-skeletal, and pharyngeal-respiratory profiles among diabetic patients with psychological problems were significantly higher than those among the control group and among diabetic patients without psychological problems. In addition, the results showed that gastrointestinal and neuro-skeletal symptoms among diabetic patients with anxiety were more prominent.
The majority of previous studies were restricted to the investigation of the prevalence of psychological problems among diabetic patients [27,28,29,30,31]. A few studies have examined the distribution of psychosomatic symptoms among diabetic patients, which include a few psychosomatic symptoms or an overall score of somatization [16, 19]. In the present study, not only the most important psychosomatic symptoms in groups with and without diabetes were compared, but also the distribution of distinct profiles of psychosomatic symptoms (extracted from factor analysis) among diabetic patients with and without psychological problems and controls was compared.
In the current study, “headache, severe fatigue, feeling low on energy, pain in the joints, and dry mouth” were the commonest psychosomatic symptoms reported among diabetic patients without psychological problems; however, there were significant differences between diabetic patients without psychological problems and controls only in terms of dry mouth. In Aikens’ study, “anenergia, memory problems, overeating, numbness, reduced libido, weakness, and faintness/dizziness” were more frequently of somatic complaints reported by diabetic patients . According to our results, diabetic patients with psychological problems reported several psychosomatic symptoms significantly higher than controls, and severe fatigue, feeling low on energy, disturbing thoughts, pain in the joints, and eyesore were more frequently reported among them. In this regard, there are evidences suggesting that the experience of high psychosomatic disorder/symptom burden is strongly associated with adverse mental health conditions such as anxiety, depression, or low self-perceived health [19, 32, 33].
Our study showed significantly higher scores of psycho-fatigue and pharyngeal-respiratory profiles in patients with diabetes than in controls, and also, diabetic patients with psychological problems had higher scores of two aforesaid profiles. In the current study, the psycho-fatigue profile is characterized by sleep disorder, pounding heart, feeling low on energy, feeling like “butterflies,” difficulty concentrating, and disturbing thoughts symptoms and the pharyngeal-respiratory profile characterized by dry mouth, neck pain, globus sensation, having trouble swallowing, shortness of breath, hoarseness, and wheezing (asthma) symptoms. According to the results of the cohort study by Baumert et al., the mean somatic symptom score was higher for the type 2 diabetes group than for non-cases of diabetes . In the aforesaid study, the somatization score was established based on stomach or bowel pain, back pain, pain in the joints, headaches or pressure in the head, temporary shortness of breath, dizziness, feeling tired, and insomnia symptoms . In addition, they showed that the risk for type 2 diabetes increased by a hazard ratio (HR) of 1.03 for a one unit increase of the somatization score . As it was mentioned, previous studies showed that psychological problems are common among diabetic patients [9,10,11,12]. It is believed that high prevalence of psychological symptoms among diabetic patients is related to poor glycemic control, diabetes complications, worsened prognosis, and quality of life .
Our results showed significantly higher scores of neuro-skeletal profile (characterized by headache, back pain, pain in the joints, eyesore, severe fatigue, dizziness and confusion, chills and extreme cold, and hot flashes) in diabetic patients with psychological problems (especially among diabetic patients with anxiety and depression) than in controls. It is showed that diabetic patients may develop several musculoskeletal symptoms, because of the severity and duration of the disease, so that these conditions may affect the joints, soft tissues, nerves, muscles, or tendons . It seems that some of these conditions stem from other complications of diabetes, such as peripheral neuropathy, and others seem to be directly caused by the metabolic abnormality, with direct glycosylation damaging tissues .
Our study showed significantly higher scores of gastrointestinal profile (characterized by chest pain, feeling of fullness, nausea, gastroesophageal reflux, pain or discomfort in the abdomen, constipation, diarrhea, bloating or swelling of the abdomen, anal pain) in diabetic patients with anxiety and depression than in controls and other diabetic patients. It is reported that gastrointestinal symptoms occur more frequently in both type 1 and type 2 diabetic patients, who exhibit higher levels of psychosocial problems [36, 37]; psychological disorders, including anxiety and depression, are strongly associated with gastrointestinal symptoms . On the other hand, acute changes in blood glucose concentration affect gastrointestinal motor function and increase perceptions of nausea, fullness, and bloating [37, 38].