University of California, San Francisco, CA, USA.
Behavioral Diabetes Institute, San Diego, CA, USA; University of California, San Diego, CA, USA.
J Diabetes Complications. 2022 Aug;36(8):108256. doi: 10.1016/j.jdiacomp.2022.108256. Epub 2022 Jul 5.
To establish cut-points and thresholds for elevated diabetes distress; document change over time; and define minimal clinically important differences (MCID) using the new Type 2 Diabetes Distress Assessment System (T2-DDAS).
A national sample of adults with type 2 diabetes completed the T2-DDAS CORE distress scale and the 7 T2-DDAS SOURCE distress scales at baseline and 6-months. Scores were computed separately for insulin- and non-insulin users. Spline regression models defined CORE cut-points and SEM formulas defined MCID. A rational "threshold" approach defined elevated SOURCE scores.
471 participants (205 insulin, 266 non-insulin) completed both assessments. Analyses yielded ≥2.0 as the cut-point for both elevated CORE and elevated SOURCE. Prevalence of elevated CORE was 61.8 % (69.9 % over 6 months). Elevated SOURCE scores varied from 30.6 % (Stigma/Shame) to 76.4 % (Management); 87.5 % indicated at least 1 elevated SOURCE score. Most (77.1 %) reported multiple elevated SOURCES. 81.8 % with elevated CORE distress at baseline remained elevated at 6 months. MCID analyses yielded +/- 0.25 as significant change. Few differences between insulin- and non-insulin users occurred.
Elevated CORE distress is highly prevalent and persistent over time; most participants reported multiple SOURCES of distress. Findings highlight the need for comprehensive assessment of diabetes distress.
确定糖尿病困扰的升高切点和阈值；记录随时间的变化；并使用新的 2 型糖尿病困扰评估系统（T2-DDAS）定义最小临床重要差异（MCID）。
一个国家的 2 型糖尿病成年人样本在基线和 6 个月时完成了 T2-DDAS CORE 困扰量表和 7 个 T2-DDAS SOURCE 困扰量表。胰岛素和非胰岛素使用者分别计算得分。样条回归模型确定了 CORE 的切点，SEM 公式定义了 MCID。一个合理的“阈值”方法定义了升高的 SOURCE 分数。
471 名参与者（205 名胰岛素使用者，266 名非胰岛素使用者）完成了两次评估。分析得出，CORE 和 SOURCE 升高的切点均为≥2.0。CORE 升高的患病率为 61.8%（6 个月时为 69.9%）。升高的 SOURCE 分数从 30.6%（耻辱/羞愧）到 76.4%（管理）不等；87.5%的人至少有一个升高的 SOURCE 分数。大多数（77.1%）报告了多个升高的 SOURCES。基线时 CORE 困扰升高的 81.8%在 6 个月时仍升高。MCID 分析得出，+/-0.25 为显著变化。胰岛素和非胰岛素使用者之间几乎没有差异。
CORE 困扰在时间上高度普遍且持续存在；大多数参与者报告了多个困扰源。这些发现强调了全面评估糖尿病困扰的必要性。
