What Is a Clinically Meaningful Change in Diabetes Distress? Findings for Diabetes Care and Research From the SFDT1...

Diabetes distress (DD) is common and evolves heterogeneously over time. We aimed to estimate minimal clinically important differences (MCID) for the Problem Areas in Diabetes (PAID) scale and its sub-dimensions and to identify predictors of worsening over 1 year in people with type 1 diabetes (PwT1D).

MCIDs for PAID total and sub-dimension scores were derived using the standard error of measurement approach. One-year DD worsening, stability and improvement were defined using the ±1 MCID threshold. We analysed changes in DD using data from the SFDT1 cohort. Logistic regression models identified predictors of worsening for PAID total and sub-dimensions, adjusting for baseline DD, age, sex and social vulnerability.

We analysed data from 2457 adults with type 1 diabetes (51.6% female, 41.3 years old (SD 14.0), 23.7 years diabetes duration (SD 14.0)). The MCID for PAID total was 5.0 points, with sub-scale MCIDs ranging from 8.5 (emotional distress) to 14.3 points (management distress). Over 1 year, 42% experienced clinically meaningful worsening of total DD, 30% improved and 28% remained stable. Worsening of total PAID was associated with social vulnerability, HbA1c increase and treatment burden. Distress trajectories varied across sub-dimensions, with emotional distress and burnout most frequently worsening (34% each); initiation of automated insulin delivery was solely associated with lower odds of worsening on the burnout dimension.

This study provides MCID values for the PAID scale and its sub-dimensions. The high temporal variability observed suggests a need for regular monitoring and clinically informed assessment of DD in PwT1D.