Diabetes distress in adults with type 1 diabetes: Prevalence, incidence and change over time

Abstract

Aims: To document the prevalence and 9-month incidence of elevated diabetes distress (DD) and the stability of DD over time using both single threshold and minimal clinically important differences (MCID) approaches.

Methods: Adults with type 1 diabetes (T1D) (N=224) completed the 28-item T1-Diabetes Distress Scale (T1-DDS) at baseline and 9months. A T1-DDS threshold was identified with spline analysis and MCID was calculated from the standard error of measurement.

Results: Analyses supported a cut-point of ≥2.0 for elevated DD. The prevalence and 9-month incidence of elevated DD was 42.1% and 54.4%, respectively. MCID was ±0.19 but varied by subscale (.26 to .50). Elevated DD was stable: only 20% crossed 2.0 over 9months. MCID analyses showed that change also occurred among those who remained either below or above 2.0 over time. Change varied by source of distress, with Powerlessness the most prevalent and stable. Using MCID, only participant age, gender and number of complications predicted change.

Conclusions: The prevalence, 9-month incidence and stability of elevated DD are high among adults with T1D, with change based on source of DD. We propose a combined cut-point/MCID framework for measuring change in DD, since each approach reflects unique characteristics of change over time.

Keywords: Change over time; Diabetes distress; Incidence; Predictors of change; Prevalence.

Conflict of interest statement

Competing Interests

No author reported a conflict of interest. Lawrence Fisher: consultant to or advisory board member for Roche Diagnostics, Elli Lilly, Novo Nordisk, Sanofi, Abbott Diabetes Care; William Polonsky: consultant or advisory board with Sanofi, Novo Nordisk, Elli Lilly, Dexcom, Abbott, J&J, Boehringer Ingelheim, Takeda, Roche; Anne Peters: consultant or advisory board with Amgen, Abbott Diabetes Care, Becton Dickinson, Biodel, Bristol Myers Squibb/Astra-Zeneca, Janssen, Lexicon, Lilly, Medtronic Minimed, Novo Nordisk, OptumRx, sanofi, Takeda, Thermalin. Speakers bureau - Bristol Myers Squibb/Astra-Zeneca, Novo Nordisk, Janssen.

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

Figure 1

Bivariate relationship of total distress (T1-DDS) with actual A1C values (dots) and predicted A1C values (line), suggesting a T1-DDS cut-point of 2.0.