title: Diabetes distress in Type 1 diabetes--a new measurement fit for purpose.
abstract: OBJECTIVE
  To examine and assess (1) the internal consistency and validity of a Danish translation of the Diabetes Distress Scale (DDS17) among adults with Type 1 diabetes mellitus, (2) the properties of the brief version of DDS17 and (3) cut points for the DDS17.
  
  
  METHODS
  Cross-sectional survey of 2419 adults with Type 1 diabetes mellitus. Validated scales and questions measured diabetes distress (DDS17), diabetes empowerment (DES-SF), healthy diet, physical activity, self-rated health (SF-12) and quality of life (WHOQoL-BREF). An electronic patient record provided information about glycaemic control (HbA(1c)). We examined internal consistency, construct validity, subscale construction and cut points for determining clinically relevant diabetes distress, as well as two- and four-item brief versions of the DDS17.
  
  
  RESULTS
  The DDS17 had a Cronbach's alpha of 0.92; subscale alphas were 0.83-0.89. A four-factor division into subscales was appropriate and the division corresponded closely to the four domains described in the development of the DDS17. The DDS17 correlated well with relevant measures; higher distress was correlated with low diabetes empowerment, low quality of life, unhealthy diet, not being physically active, poor glycaemic control and low scores on the mental component score of the SF-12. A two-item brief scale performed as well as a four-item version. The relationship between DDS17 and outcomes did not suggest distinct cut points for DDS17.
  
  
  CONCLUSIONS
  Our results provide support for the use of this Danish adaptation of the DDS17 for assessing psychosocial distress among adults with Type 1 diabetes mellitus.
authors.affiliation: Steno Health Promotion Center, Steno Diabetes Center, Gentofte, Denmark. ljoe@steno.dk
authors.forename: L E
authors.initials: LE
authors.lastname: Joensen
authors.forename: I
authors.initials: I
authors.lastname: Tapager
authors.forename: I
authors.initials: I
authors.lastname: Willaing
mesh_terms: D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003718:Denmark; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology* / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006293:Health Promotion; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D007802:Language; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D015203:Reproducibility of Results; D012648:Self Care; D020377:Self Efficacy; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human