Female gender was associated with increased risk of diabetes distress after adjustment for potential confounding factors such as age, insulin use, HbA1c, smoking status, interpreter use, medication adherence, diet difficulty, physical activity, glucose monitoring, likely depression, use of antidepressant medications or counselling and own health rating [1.59 (1.11–2.27), p = 0.012]. Here, INS is linked to depressive disorder.