American Diabetes Association
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A short-form measure of diabetes distress among adults with type 1 diabetes for use in clinical practice: Development and validation of the T1-DDS-7

posted on 2023-06-21, 21:25 authored by Mette Nygaard, Ingrid Willaing, Lene Eide Joensen, Pil Lindgreen, Vibeke Stenov, Danielle Hessler, Kirsten Nørgaard, Ulrik Pedersen-Bjergaard, Kasper Olesen


Objective: Valid and reliable diabetes distress assessment is essential for identifying adults with elevated levels of concern and to guide targeted support. However, assessing diabetes distress must also be feasible in time-limited settings. We aimed to identify a short-form measure of the 28-item Type 1 Diabetes Distress Scale (T1-DDS-28) representing seven sources of type 1 diabetes distress that would be convenient for use in clinical practice.

Research Design and Methods: Based on the evaluation of influence and importance by 14 experts in diabetes care and research, we identified the best-performing item within each of seven sources of diabetes distress included in the T1-DDS-28. To further validate the proposed short-form measure, we used survey data from 2,016 adults living with type 1 diabetes. Validity was examined by exploratory factor analysis, Cronbach’s alpha, test-retest reliability analysis, and correlations with other psychosocial measures. 

Results: We identified a short-form measure of the T1-DDS-28 consisting of seven items, each representing a source of diabetes distress. These items showed satisfactory reliability (factor loadings>0.45; α=0.82; test-retest correlation, r=0.90) and validity (correlation with T1-DDS-28, r=0.95; AUC=0.91; sensitivity 93%; specificity 89%) when combined in the short-form scale (T1-DDS-7). 

Conclusions: We propose the T1-DDS-7 as a valid and reliable measure for routine screening of diabetes distress among adults with type 1 diabetes. In case of elevated levels of diabetes distress, we recommend that a full-scale assessment and open dialogue follow the short-form measure before determining further treatment. 


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.


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