When is Diabetes Distress Clinically Meaningful?: Establishing Cut Points for the Diabetes Distress Scale
Overview
Affiliations
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.
Arunraj M, Vijay V, Kumpatla S, Viswanathan V Indian J Med Res. 2025; 161(1):72-80.
PMID: 40036104 PMC: 11878655. DOI: 10.25259/IJMR_1227_2024.
Williams E, Juarez L, Presley C, Agne A, Cherrington A, Howell C J Gen Intern Med. 2025; .
PMID: 40029547 DOI: 10.1007/s11606-025-09367-z.
Sharif S, Sharif H, Rehman J, Fatima Z BMJ Public Health. 2025; 1(1):e000149.
PMID: 40017838 PMC: 11816276. DOI: 10.1136/bmjph-2023-000149.
Almarzooq M, Almarzoug H, Alhassan M, Alrashed M, Alnajjar J, Albejais N Medicina (Kaunas). 2025; 61(2).
PMID: 40005351 PMC: 11857536. DOI: 10.3390/medicina61020234.
Roth M, Bodenhofer J, Fischill-Neudeck M, Roth C, Domhardt M, Emsenhuber G Diabetes Spectr. 2025; 38(1):58-67.
PMID: 39959529 PMC: 11825395. DOI: 10.2337/ds24-0012.