skip to main content

A Pilot Study on Diabetes Distress, Insulin Growth Factor-I, Insulin-Like Growth Factor Binding Protein-3, and HbA1c in Diabetic Patients

*Tahiruddin Tahiruddin orcid scopus publons  -  Sekolah Tinggi Ilmu Kesehatan (STIKes) Karya Kesehatan, Indonesia
Diah Indriastuti orcid scopus publons  -  Bachelor of Nursing Study Program, Faculty of Medicine, Halu Oleo University, Indonesia
Syahrul Syahrul orcid  -  Department of Community and Family Health Nursing, Faculty of Nursing, Universitas Hasanuddin, Indonesia
Andi Masyitha Irwan orcid  -  Department of Community and Family Health Nursing, Faculty of Nursing, Universitas Hasanuddin, Indonesia
Satriya Pranata orcid  -  Department of Nursing, Faculty of Nursing and Health Sciences, Universitas Muhammadiyah Semarang, Indonesia
Open Access Copyright (c) 2025 by the Authors, Published by Department of Nursing, Faculty of Medicine, Universitas Diponegoro
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Citation Format:
Abstract

Background: Diabetes distress refers to the emotional and psychological burden experienced by individuals in managing their condition, which can influence physiological outcomes and overall well-being. However, the relationship between HbA1c, insulin growth factor-I (IGF-I), and insulin-like growth factor binding protein-3 (IGFBP-3) with diabetes distress in diabetic patients remains elusive.  

Purpose: The objective of this study was to evaluate the association of IGF-I, IGFBP-3, and HbA1c with diabetes distress in diabetic patients.

Methods: A cross-sectional design with purposive sampling was used to recruit subjects from the public health center in Kendari City, Southeast Sulawesi, Indonesia, from May to November 2021. A total of 30 diabetic patients were recruited. Distress data were collected using the Indonesian version of the Diabetes Distress Scale (DDS) questionnaire. HbA1c levels were measured using High-Performance Liquid Chromatography (HPLC). Serum levels of IGF-I and IGFBP-3 were measured using the ELISA (Enzyme-Linked Immunosorbent Assay) kit method. The data were analyzed using regression analysis.

Results: Most respondents had moderate distress, with a DDS score of 53.4%, high IGF-I levels in 76.7%, and low IGFBP-3 levels in 76.7%. As many as 60% of respondents had an HbA1c level above 6.4%. IGF-I (ρ-value = 0.024) and IGFBP-3 levels (ρ-value = 0.042) were significantly correlated with diabetes distress. However, HbA1c levels were not significantly correlated with diabetes distress (ρ-value = 0.155).

Conclusion: IGF-I and IGFBP-3 levels were associated with diabetes distress, but HbA1c was not. Patients with higher distress were found to have elevated serum levels of IGF-I and IGFBP-3. Future research should focus on stress management strategies that support efforts to prevent disease and complications associated with diabetes mellitus.

Fulltext
Keywords: Diabetes; HbA1c; IGF-I; IGFBP-3
Funding: Ministry of Education and Culture, Republic of Indonesia

Article Metrics:

  1. Abdlwhab, H. M., Al-saffar, A., Mahdi, O. A., & Alameri, R. B. (2024). The impact of insulin resistance and glycaemic control on insulin-like growth factor-1 in patients with type 2 diabetes : a cross- sectional study. Clinical Diabetes and Endocrinology, 10(36). https://doi.org/https://doi.org/10.1186/s40842-024-00202-8
  2. Aguirre, G. A., Ita, J. R., Garza, R. G. de la, & Castilla-Cortazar, I. (2016). Insulin-like growth factor-1 deficiency and metabolic syndrome. Journal of Translational Medicine, 14(3), 1–23. https://doi.org/10.1186/s12967-015-0762-z
  3. Aljuaid, M. O., Almutairi, A. M., Assiri, M. A., Almalki, D. M., & Alswat, K. (2018). Diabetes-related distress assessment among type 2 diabetes patients. Journal of Diabetes Research, 2018(1). https://doi.org/10.1155/2018/7328128
  4. AlOtaibi, A. A., Almesned, M., Alahaideb, T. M., Almasari, S. M., & Alsuwayt, S. S. (2021). Assessment of diabetes‑related distress among type 2 diabetic patients, Riyadh, Saudi Arabia. Journal of Family Medicine and Primary Care, 10(3481–9). https://doi.org/10.4103/jfmpc.jfmpc
  5. Alves-Bezerra, M., & Cohen, D. E. (2019). Triglyceride metabolism in the liver. Comprehensive Physiology, 8(1), 1–22. https://doi.org/10.1002/cphy.c170012
  6. American Diabetes Association. (2020). Standards of medical care in diabetes―2020. The Journal of Clinical and Applied Research and Educational and Applied : Diabetes Care, 43(1), S98–S110. https://doi.org/10.2337/dc20-S009
  7. Aneke-Nash, C. S., Parrinello, C. M., Rajpathak, S. N., Rohan, T. E., Strotmeyer, E. S., Kritchevsky, S. B., Psaty, B. M., Bůžková, P., Kizer, J. R., Newman, A. B., Strickler, H. D., & Kaplan, R. C. (2015). Changes in insulin-like growth factor-I and its binding proteins are associated with diabetes mellitus in older adults. Journal of the American Geriatrics Society, 63(5), 902–909. https://doi.org/10.1111/jgs.13390
  8. Arifin, B., Asselt, A. D. I. Van, Setiawan, D., Atthobari, J., Postma, M. J., & Cao, Q. (2019). Diabetes Distress in Indonesian Patients with Type 2 Diabetes : A Comparison Between Primary and Tertiary Care. BMC Health Services Research, 19(773), 1–11
  9. Arifin, B., Perwitasari, D. A., Thobari, J. A., Cao, Q., Krabbe, P. F. M., & Postma, M. J. (2017). Translation, Revision, and Validation of the Diabetes Distress Scale for Indonesian Type 2 Diabetic Outpatients with Various Types of Complications. Value in Health Regional Issues, 12, 63–73. https://doi.org/10.1016/j.vhri.2017.03.010
  10. Baradaran, H. R., Mirghorbani, S.-M., Javanbakht, A., Yadollahi, Z., & Khamseh, M. E. (2013). Diabetes distress and its association with depression in patients with type 2 diabetes in iran. International Journal of Preventive Medicine, 4(5), 580–584. http://www.ncbi.nlm.nih.gov/pubmed/23930169
  11. Batais, M. A., Alfraiji, A. F., Alyahya, A. A., Aloofi, O. A., Almashouq, M. K., Alshehri, K. S., Almizel, A. M., Alotaibi, M. T., & Alosaimi, F. D. (2021). Assessing the Prevalence of Diabetes Distress and Determining Its Psychosocial Predictors Among Saudi Adults With Type 2 Diabetes : A Cross-Sectional Study. Frontiers in Psychology, 12(759454), 1–12. https://doi.org/10.3389/fpsyg.2021.759454
  12. Biadgo, B., Tamir, W., & Ambachew, S. (2020). Insulin-like growth factor and its therapeutic potential for diabetes complications-mechanisms and metabolic links: A review. Review of Diabetic Studies, 16(1), 24–34. https://doi.org/10.1900/RDS.2020.16.24
  13. Botros, R. M., El-Sherbeeny, A. A. A., Barbary, N. S. El, Muhammed, A. M., & Ali, H. M. (2020). Study of the effect of nutrition and glycemic control and on IGF-1 and growth in pre-pubertal egyptian children with T1DM. Egyptian Journal of Hospital Medicine, 81(5), 2084–2087. https://doi.org/10.21608/EJHM.2020.126407
  14. Chinedu, A. C., & Foluso, O. (2023). Diabetes Distress: The Untold Hidden Struggle of Living with Diabetes Mellitus. African Journal of Health, Nursing and Midwifery, 6(2), 99–111. https://doi.org/10.52589/ajhnm-98vrwpip
  15. Clemmons, D. R. (2012). Metabolic Actions of IGF-I in Normal Physiology and Diabetes. Endocrinol Metab Clin North Am, 41(2), 235–242. https://doi.org/10.1007/978-3-642-23635-8_30
  16. Clemmons, D. R. (2018). Role of igf-binding proteins in regulating igf responses to changes in metabolism. Journal of Molecular Endocrinology, 61(1), T139–T169. https://doi.org/10.1530/JME-18-0016
  17. Drogan, D., Schulze, M. B., Boeing, H., & Pischon, T. (2016). Insulin-Like Growth Factor 1 and Insulin-Like Growth Factor–Binding Protein 3 in Relation to the Risk of Type 2 Diabetes Mellitus: Results From the EPIC– Potsdam Study. American Journal of Epidemiology, 183(6), 553–560. https://doi.org/10.1093/aje/kwv188
  18. Duggan, C., Wang, C., Neuhouser, M. L., Xiao, L., Smith, A. W., Reding, K. W., Richard, N., Baumgartner, K. B., Bernstein, L., Ballard-, R., & Mctiernan, A. (2014). Associations of insulin-like growth factor and insulin-like growth factor binding protein-3 with mortality in women with breast cancer. 132(5), 1191–1200. https://doi.org/10.1002/ijc.27753.Associations
  19. Elotla, S. F., Fouad, A. M., Mohamed, S. F., Joudeh, A. I., Mostafa, M., Hayek, S. El, Shah, J., & Ahmed, H. A. S. (2022). Association between diabetes-related distress and glycemic control in primary care patients with Type 2 diabetes during the coronavirus disease 2019 (COVID-19) pandemic in Egypt. Journal of Family and Community Medicine, 30(1), 42–50. https://doi.org/10.4103/jfcm.jfcm_238_22
  20. Fraenkel, E., & Lazurova, I. (2023). IGF-1 and IGFBP3 as indirect markers of hepatic insulin resistance and their relation to metabolic syndrome parameters in liver steatosis patients. Endocrine Regulations, 57(1), 69–79. https://doi.org/10.2478/enr-2023-0009
  21. Gedikli, M. A., Kalın, B. S., & Sivas, A. A. (2022). Relationship Between HbA1c Level and Triglyceride/HDL Cholesterol Ratio and Triglyceride Glucose Index in Diabetes Patients. Bagcilar Medical Bulletin, 7(1), 27–31. https://doi.org/10.4274/BMB.galenos.2022.2021.09.095
  22. Harris, M. L., Oldmeadow, C., Hure, A., Luu, J., Loxton, D., & Attia, J. (2017). Stress increases the risk of type 2 diabetes onset in women: A 12-year longitudinal study using causal modelling. PLOS ONE, 12(2), 1–13. https://doi.org/10.1371/journal.pone.0172126
  23. Hatting, M., Tavares, C. D. J., Sharabi, K., Rines, A. K., & Puigserver, P. (2018). Insulin regulation of gluconeogenesis. Annals of the New York Academy of Sciences, 1411(1), 21–35. https://doi.org/10.1111/nyas.13435
  24. Hilliard, M. E., Yi-Frazier, J. P., Hessler, D., Butler, A. M., Anderson, B. J., & Jaser, S. (2016). Stress and A1c Among People with Diabetes Across the Lifespan. Curr Diab Rep, 16(8), 139–148. https://doi.org/10.1007/s11892-016-0761-3.Stress
  25. Hu, Y., Li, L., & Zhang, J. (2020). Diabetes Distress in Young Adults with Type 2 Diabetes: A Cross-Sectional Survey in China. Journal of Diabetes Research, 2020, 6–8. https://doi.org/10.1155/2020/4814378
  26. International Diabetes Federation. (2019). IDF Diabetes Atlas: Ninth Edition 2019 (9th ed.). International Diabetes Federation
  27. Jeong, M., & Reifsnider, E. (2018). Associations of Diabetes- Related Distress and Depressive Symptoms With Glycemic Control in Korean Americans With Type 2 Diabetes. The Diabetes Educator, 44(6). https://doi.org/10.1177/0145721718807443
  28. Joseph, J. J., & Golden, S. H. (2018). Cortisol Dysregulation: The Bidirectional Link Between Stress, Depression, and Type 2 Diabetes Mellitus Joshua. Ann N Y Acad Sci, 1391(1). https://doi.org/10.1111/nyas.13217
  29. Kalra, S., Jena, B. N., & Yeravdekar, R. (2018). Emotional and psychological needs of people with diabetes. Indian Journal of Endocrinology and Metabolism, 22(5), 696–704. https://doi.org/10.4103/ijem.IJEM_579_17
  30. Kasprzak, A. (2021). Insulin-like growth factor 1 (Igf-1) signaling in glucose metabolism in colorectal cancer. International Journal of Molecular Sciences, 22(12). https://doi.org/10.3390/ijms22126434
  31. Kim, S.-H., & Park, M.-J. (2017). Effects of growth hormone on glucose metabolism and insulin resistance in human. Annals of Pediatric Endocrinology & Metabolism, 22(3), 145–152. https://doi.org/10.6065/apem.2017.22.3.145
  32. Kim, S. Y., Kim, M., Oh, Y., & Lee, D. Y. (2021). Relationship of Serum Total Insulin-Like Growth Factor Binding Protein-3 with Insulin-Like Growth Factor-I and Glucose Tolerance in Korean Children and Adolescents. International Journal of Endocrinology, 2021. https://doi.org/10.1155/2021/9966114
  33. Klop, B., Elte, J. W. F., & Cabezas, M. C. (2013). Dyslipidemia in Obesity: Mechanisms and Potential Targets. Nutrients, 5(4), 1218–1240. https://doi.org/10.3390/nu5041218
  34. Kristaningrum, N. D., Ramadhani, D. A., Hayati, Y. S., & Setyoadi. (2021). Correlation between the burden of family caregivers and health statuof people with diabetes mellitus. Journal of Public Health Research, 10(2), 326–331. https://doi.org/10.4081/jphr.2021.2227
  35. Liu, B., & Wang, Y. (2024). Predictive value of IGF-1/IGFBP-3 ratio for thyroid nodules in type 2 diabetic mellitus. Frontiers in Endocrinology, 15(October), 1–10. https://doi.org/10.3389/fendo.2024.1444279
  36. NeamŢu, M. C., Avramescu, E. T., Marcu, I. R., Turcu-Ştiolică, A., Boldeanu, M. V., NeamŢu, O. M., Tudorache, Ş., & Dănciulescu Miulescu, R. E. (2017). The correlation between insulin-like growth factor with glycemic control, glomerular filtration rate, blood pressure, hematological changes or body mass index in patients with type 2 diabetes mellitus. Romanian Journal of Morphology and Embryology = Revue Roumaine de Morphologie et Embryologie, 58(3), 857–861. http://www.ncbi.nlm.nih.gov/pubmed/29250665
  37. Oguni, K., Yamamoto, K., Nakano, Y., Soejima, Y., Suyama, A., Takase, R., Yasuda, M., Hasegawa, K., & Otsuka, F. (2024). Trends of correlations between serum levels of growth hormone and insulin-like growth factor-I in general practice. Frontiers in Endocrinology, 15. https://doi.org/10.3389/fendo.2024.1381083
  38. Önal, Z. E., Atasayan, V., Akici, N., Gürbüz, T., & Nuhoglu, Ç. (2014). The Relationship between Glycosylated Haemoglobin (HbA1c) Levels and Serum Lipid Profiles in Insulin Resistant Children. Hong Kong Journal of Paediatrics, 19(1), 22–27
  39. Pankiv, V. I., & Yuzvenko, T. Y. (2023). The relationships between variables of glycated hemoglobin and diabetes distress in patients with type 1 and type 2 diabetes mellitus. Miznarodnij Endokrinologicnij Zurnal, 19(6), 424–427. https://doi.org/10.22141/2224-0721.19.6.2023.1310
  40. Polonsky, W. H., Fisher, L., Earles, J., Dudl, R. J., Lees, J., Mullan, J., & Jackson, R. A. (2005). Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes Care, 28(3), 626–631. https://doi.org/10.2337/diacare.28.3.626
  41. Pratiwi, P., Amatiria, G., & Yamin, M. (2014). Pengaruh Stress Terhadap Kadar Gula Darah Sewaktu Pada Pasien Diabetes Melitus Yang Menjalani Hemodialisa. Jurnal Kesehatan, 5(1), 11–16. https://doi.org/https://doi.org/10.26630/jk.v5i1.59
  42. Ramkisson, S. (2017). Social Support and Coping in Adults with Type 2 Diabetes. African Journal of Primary Health Care & Family Medicine, 9(1), 1–8. https://doi.org/https://doi. org/10.4102/phcfm. v9i1.1405 Copyright:
  43. Ranke, M. B. (2015). Insulin-like growth factor binding-protein-3 (IGFBP-3). Best Practice and Research: Clinical Endocrinology and Metabolism, 29(5), 701–711. https://doi.org/10.1016/j.beem.2015.06.003
  44. Sandler, C. N., & McDonnell, M. E. (2022). The role of hemoglobin A1c in the assessment of diabetes and cardiovascular risk. Cleveland Clinic Journal of Medicine, 83(1), 4–10. https://doi.org/10.3949/ccjm.83.s1.02
  45. Sapra, A., & Bhandari, P. (2023). Diabetes. StatPearls Publishing LLC. https://www.ncbi.nlm.nih.gov/books/NBK551501/
  46. Schnell, O., Crocker, J. B., & Weng, J. (2017). Impact of HbA1c Testing at Point of Care on Diabetes Management. Journal of Diabetes Science and Technology, 11(3). https://doi.org/10.1177/1932296816678263
  47. Setia, M. S. (2016). Methodology series module 3: Cross-sectional studies. Indian Journal of Dermatology, 61(3), 261–264. https://doi.org/10.4103/0019-5154.182410
  48. Sherwani, S. I., Khan, H. A., Ekhzaimy, A., Masood, A., & Sakharkar, M. K. (2016). Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomarker Insights, 11, 95–104. https://doi.org/10.4137/Bmi.s38440
  49. Similä, M. E., Kontto, J. P., Virtamo, J., Hätönen, K. A., & Valsta, L. M. (2019). Insulin-like growth factor I , binding proteins -1 and -3 , risk of type 2 diabetes and macronutrient intakes in men. British Journal OfNutrition, 121, 938–944. https://doi.org/10.1017/S0007114519000321
  50. Skinner, T. C., Joensen, L., & Parkin, T. (2020). Twenty-five years of diabetes distress research. Diabetic Medicine, 37(3), 393–400. https://doi.org/10.1111/dme.14157
  51. Stoop, C., Pouwer, F., Pop, V., Oudsten, B. Den, & Nefs, G. (2019). Psychosocial Health Care Needs of People with Type 2 Diabetes in Primary Care : Views of Patients and Health Care Providers. Journal of Advanced Nursing, 75, 1702–1712. https://doi.org/10.1111/jan.13996
  52. Thau, L., Gandhi, J., & Sharma, S. (2023). Physiology, Cortisol. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538239/
  53. Vasilkova, V. N., Mokhort, T. V., Pchelin, I. Y., Bayrasheva, V. K., Naumenko, E. P., Korotaeva, L. E., & Filiptsova, N. A. (2021). Association between serum insulin like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein-3 levels and chronic kidney disease in diabetic patients. Journal of Renal Injury Prevention, 10(1), 1–6. https://doi.org/10.34172/jrip.2021.05
  54. Vedantam, D., Poman, D. S., Motwani, L., Asif, N., Patel, A., & Anne, K. K. (2022). Stress-Induced Hyperglycemia: Consequences and Management. Cureus, 1(7), 1–13. https://doi.org/10.7759/cureus.26714
  55. Wang, X., & Cheng, Z. (2020). Cross-Sectional Studies: Strengths, Weaknesses, and Recommendations. Chest, 158(1S), S65–S71. https://doi.org/10.1016/j.chest.2020.03.012
  56. Wei, L., Liping, Z., & Suya, K. (2023). Expression of insulin-like growth factor binding protein-3 in HELLP syndrome. BMC Pregnancy and Childbirth, 23(1), 1–17. https://doi.org/10.1186/s12884-023-06074-7
  57. Wennberg, A. M. V, Hagen, C. E., Machulda, M. M., Hollman, J. H., Roberts, R. O., Knopman, D. S., Petersen, R. C., & Mielke, M. M. (2018). The association between peripheral total IGF-1, IGFBP-3, and IGF-1/IGFBP-3 and functional and cognitive outcomes in the Mayo Clinic Study of Aging. Neurobiology of Aging, 66, 68–74. https://doi.org/https://doi.org/10.1016/j.neurobiolaging.2017.11.017
  58. Wibowo, Z. K., Wibisono, S., & Khairina. (2022). The relationship between diabetes distress and HbA1C level in type 2 diabetes mellitus therapy patients: a systematic review. Bali Medical Journal, 11(1), 476–484. https://doi.org/10.15562/bmj.v11i1.2986
  59. Young-Hyman, D., De Groot, M., Hill-Briggs, F., Gonzalez, J. S., Hood, K., & Peyrot, M. (2016). Psychosocial care for people with diabetes: A position statement of the American diabetes association. Diabetes Care, 39(12), 2126–2140. https://doi.org/10.2337/dc16-2053
  60. Young, B. M. O. E. E., Okafor, C. B. N. C. I., & Ugwueze, C. V. (2020). Diabetes Distress and Associated Factors in Patients with Diabetes Mellitus in South East Nigeria. Dubai Diabetes Endocrinol Journal, 26(31), 31–37. https://doi.org/10.1159/000508706
  61. Zamani-Alavijeh, F., Araban, M., Koohestani, H. R., & Karimy, M. (2018). The effectiveness of stress management training on blood glucose control in patients with type 2 diabetes. Diabetology and Metabolic Syndrome, 10(1), 1–9. https://doi.org/10.1186/s13098-018-0342-5
  62. Zhao, X., An, X., Yang, C., Sun, W., Ji, H., & Lian, F. (2023). The crucial role and mechanism of insulin resistance in metabolic disease. Frontiers in Endocrinology, 14(1149239). https://doi.org/10.3389/fendo.2023.1149239

Last update:

No citation recorded.

Last update: 2025-05-03 10:01:11

No citation recorded.