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. 2012 Feb;35(2):259-64.
doi: 10.2337/dc11-1572. Epub 2012 Jan 6.

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

Lawrence Fisher  1 , Danielle M Hessler, William H Polonsky, Joseph Mullan
Affiliations

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

Lawrence Fisher et al. Diabetes Care. 2012 Feb.

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.

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Figures

Figure 1
Figure 1
Associations between 3D Study DDS17 scores and the key diabetes variables of HBA1c (A), self-efficacy (B), healthy diet (C), and physical activity (D) using fitted quadratic lines.
See this image and copyright information in PMC

References

    1. Gonzalez JS, Fisher L, Polonsky WH. Depression in diabetes: have we been missing something important? Diabetes Care 2011;34:236–239 - PMC - PubMed
    1. Fisher L, Mullan JT, Arean P, Glasgow RE, Hessler D, Masharani U. Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care 2010;33:23–28 - PMC - PubMed
    1. Fisher L, Skaff MM, Mullan JT, Arean P, Glasgow R, Masharani U. A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetes. Diabet Med 2008;25:1096–1101 - PMC - PubMed
    1. Fisher L, Skaff MM, Mullan JT, et al. Clinical depression versus distress among patients with type 2 diabetes: not just a question of semantics. Diabetes Care 2007;30:542–548 - PubMed
    1. Fisher L, Mullan J, Skaff M, Glasgow R, Arean P, Hessler D. Predicting disease distress among primary care patients with type 2 diabetes: a longitudinal study. Diabet Med 2009;26:622–627 - PMC - PubMed

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