Abstract
OBJECTIVES: Using network analysis, which takes a holistic approach to health systems, we aimed to identify which psychosocial burden dimensions are the most central and, thus, critical to prioritising to improve the overall health of people with type 1 diabetes (PwT1D). DESIGN: A cross-sectional network analysis. SETTING: We used data from participants attending 44 diabetes centres in France, who were enrolled in the SFDT1 cohort study between June 2020 and February 2024. PARTICIPANTS: We included 1430 PwT1D (52% women, median age (IQR) 41 (31-52.8) years) who had completed questionnaires on diabetes burden. OUTCOME MEASURES: The items from questionnaires on diabetes distress, fear of hypoglycaemia, quality of life, treatment burden and the impact of diabetes on education and work. RESULTS: The network was highly stable (correlation stability coefficient=0.75). We observed nine domains within the network; 'Loneliness, Worrying & Burnout' was the most influential. We further grouped the domains into three distinct syndromes labelled 'Diabetes Distress', 'Treatment Burden' and 'Impact of Diabetes on Life'. These syndromes reflect the most relevant pillars of the psychosocial burden in PwT1D. CONCLUSIONS: We observed that 'Loneliness, Worrying & Burnout' is the most influential psychosocial burden network domain to prioritise for type 1 diabetes care. This new network-based approach opens the path to defining personalised interventions targeting the most critical burden parameters to expect the most significant overall beneficial impact on PwT1D's health. TRIAL REGISTRATION NUMBER: NCT04657783.