When is diabetes distress clinically meaningful?: establishing cut points for the Diabetes Distress Scale

Authors: Fisher, L., Hessler, DM., Polonsky, WH., Mullan, J.

Abstract

Objective: To identify the pattern of relationships between the 17-item Diabetes Distress Scale (DDS17) and diabetes variables to establish scale cut points for high distress among patients with type 2 diabetes.

Research design and methods: Recruited were 506 study 1 and 392 study 2 adults with type 2 diabetes from community medical groups. Multiple regression equations associated the DDS17, a 17-item scale that yields a mean-item score, with HbA(1c), diabetes self-efficacy, diet, and physical activity. Associations also were undertaken for the two-item DDS (DDS2) screener. Analyses included control variables, linear, and quadratic (curvilinear) DDS terms.

Results: Significant quadratic effects occurred between the DDS17 and each diabetes variable, with increases in distress associated with poorer outcomes: study 1 HbA(1c) (P < 0.02), self-efficacy (P < 0.001), diet (P < 0.001), physical activity (P < 0.04); study 2 HbA(1c) (P < 0.03), self-efficacy (P < 0.004), diet (P < 0.04), physical activity (P = NS). Substantive curvilinear associations with all four variables in both studies began at unexpectedly low levels of DDS17: the slope increased linearly between scores 1 and 2, was more muted between 2 and 3, and reached a maximum between 3 and 4. This suggested three patient subgroups: little or no distress, <2.0; moderate distress, 2.0-2.9; high distress, ≥3.0. Parallel findings occurred for the DDS2.

Conclusions: In two samples of type 2 diabetic patients we found a consistent pattern of curvilinear relationships between the DDS and HbA(1c), diabetes self-efficacy, diet, and physical activity. The shape of these relationships suggests cut points for three patient groups: little or no, moderate, and high distress.

Source: https://pubmed.ncbi.nlm.nih.gov/22228744/

Share the Post:

BDI Monthly Events

July 9Case Consultation
BDI hosts the San Diego-wide, monthly case consultation meeting (for mental health professionals working in the field of diabetes). Contact us at [email protected] if you are in the greater San Diego area and would like further information about this program.
July 18Grownup T1D
July 18: Time for another T1D meet-up! GrownupT1Ds, a wonderful nonprofit here in southern California, is teaming up with TCOYD and BDI for a special Friday afternoon (3 pm - 6 pm) you won’t want to miss. Dr. Edelman (famed endocrinologist, TCOYD Founder and living with T1D) and Dr. Polonsky (BDI President) will be speaking, and it will be a chance to hang out with other adults with T1D. The event will be held at TCOYD, 5720 Oberlin Drive, Suite 150, San Diego, CA 92121. While the event is free, space is limited, so please RSVP https://grownupt1ds.org/.
August 8-10TCOYD ONE
August 8 – 10. Taking Control of Your Diabetes (TCOYD) will be hosting the in-person ONE event, an amazing weekend experience here in San Diego for more than 500 people with type 1 diabetes and their loved ones. Dr. Polonsky is honored to be one of the presenters, and we will hope to see many of you there. There are still a few spaces left, so if you’d like to know more, please visit: https://tcoyd.org/one-2025/