Department of Family & Community Medicine, University of California, San Francisco, San Francisco, California, USA.
Diabetes Care. 2012 Feb;35(2):259-64. doi: 10.2337/dc11-1572. Epub 2012 Jan 6.
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.
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.
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.
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.
确定 17 项糖尿病困扰量表（DDS17）与糖尿病变量之间关系的模式，为 2 型糖尿病患者建立高困扰的量表切点。
从社区医疗小组招募了 506 名研究 1 和 392 名研究 2 的成年 2 型糖尿病患者。多元回归方程将 DDS17（一种产生平均项目得分的 17 项量表）与 HbA（1c）、糖尿病自我效能、饮食和身体活动相关联。还对两项 DDS（DDS2）筛查器进行了关联分析。分析包括控制变量、线性和二次（曲线）DDS 项。
DDS17 与每个糖尿病变量之间均存在显著的二次效应，困扰程度的增加与较差的结果相关：研究 1 HbA（1c）（P < 0.02）、自我效能（P < 0.001）、饮食（P < 0.001）、身体活动（P < 0.04）；研究 2 HbA（1c）（P < 0.03）、自我效能（P < 0.004）、饮食（P < 0.04）、身体活动（P = NS）。在两项研究中，与所有四个变量的实质性曲线关联始于异常低的 DDS17 水平：分数在 1 到 2 之间呈线性增加，在 2 到 3 之间变得更为柔和，在 3 到 4 之间达到最大值。这表明存在三个患者亚组：几乎没有或没有困扰，<2.0；中度困扰，2.0-2.9；高度困扰，≥3.0。DDS2 也存在类似的发现。
在两个 2 型糖尿病患者样本中，我们发现 DDS 与 HbA（1c）、糖尿病自我效能、饮食和身体活动之间存在一致的曲线关系模式。这些关系的形状表明了三个患者组的切点：几乎没有或没有困扰、中度困扰和高度困扰。
