The Validity and Reliability of Japanese Version of the Diabetes Distress Scale for Adult Patients with Type 2 Diabetes

Abstract

Diabetes related distress is common for patients with type 2 diabetes (T2D), which exacerbates glycemic control through negative effects on emotional and physical well-being and self-care behaviors. Diabetes Distress Scale (DDS) is a widely used instrument to measure diabetes related distress. The aim of this study was to develop the Japanese version of the DDS (DDS-J) and examine its psychometric properties. DDS-J was developed conceptually equivalent to the original English version by forward and backward translations and adjustments of inappropriate terms. The investigation was conducted in 132 (mean age 64.5 years, 67.4% male, mean duration 14.2 years, mean HbA1c 7.7%) T2D patients at outpatient department of 2 hospitals in Aichi, Japan from February to March 2017. Cronbach’s α was used to assess reliability, and factor analysis to analyze validity. The 5-item World Health Organization Well-Being Index (WHO-5) and Patient Health Questionnaire-9 (PHQ-9) scale were adopted to evaluate the criteria-related validity. The scores of DDS-J, WHO-5 and PHQ-9 were calculated, then their relationship analyzed using Pearson correlation analysis. Four factors of regimen-related distress (RD), emotional burden (EB), physician-related distress (PD), and diabetes-related interpersonal distress (ID) were extracted by exploratory factor analysis. This factor structure was the same as the original. The overall Cronbach’s α was 0.91, while ones for RD, EB, PD, and ID were 0.86, 0.87, 0.73 and 0.86, respectively. The total DDS-J score was 24.4±18.7, WHO-5 15.3±5.4 and PHQ-9 3.5±4.4. The total DDS-J score showed a weak but significant correlation with WHO-5 (r=-0.376, p<0.01) and PHQ-9 (r=0.425, p<0.01). In conclusion, DDS-J have good validity and reliability, and can be used as an effective tool to assess diabetes related distress of Japanese adult T2D patients. Furthermore, diabetes related distress is associated with well-being and depression in the studied patients. Disclosure H. Matsumoto: None. K. Okazaki: Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Taisho Pharmaceutical Co., Ltd.. Speaker's Bureau; Self; Ono Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk A/S, Astellas Pharma US, Inc., Takeda Development Center Asia, Pte. Ltd., Terumo Medical Corporation, MSD K.K., Sanwa Kagaku Kenkyusho Co., Ltd.. Other Relationship; Self; Aichi prefecture government and Nagoya city government. T. Oya: None. N. Takahashi: Other Relationship; Self; Archie prefecture government and Nagoya city government. M. Suematsu: Other Relationship; Self; Aichi prefecture government and Nagoya city government.