Validation of the Diabetes Distress Scale in an Asian Pacific Islander Population

Diabetes distress (DD) generally refers to the emotional and cognitive stress caused by the daily management of diabetes. The Diabetes Distress Scale (DDS)-17 is a 17-item instrument that is frequently used to screen DD and the Fisher's DDS2, developed by Fisher, et al, is a two-item instrument to quickly identify DD. However, these scales have been validated in Caucasian populations but not in Asian Pacific Islander (API) populations. This study aimed to 1) evaluate content validity of the DDS17 by evaluating correlation with hemoglobin A1c and 2) identify two items to develop a brief screening tool, DDS2, for an API population. We conducted a retrospective chart review of 443 patients at a diabetes center in Hawai'i. On their initial visit, patients filled out the DDS17 as a part of the standard of care. The DDS17 showed high reliability (Cronbach's alpha = 0.94). The two items of our DDS2 with the highest phi coefficient (0.59 each) to the total DDS17 subscales were selected from the interpersonal distress and the emotional burden subscales. The phi coefficient (0.74) of our DDS2 was higher than that of the Fisher's DDS2 (0.60). All DDS items showed positive correlation with hemoglobin A1c (DDS17: r = 0.18, DDS2: r = 0.16, Fisher's DDS2: r = 0.21, respectively). Therefore, these scales can be used to measure DD in an API population and the positive correlation suggests that addressing DD may improve glycemic control and vice versa. Clinicians with limited time may consider using our DDS2 rather than DDS17 to quickly screen the API population for DD.