Diabetes Distress leads to frustration, anger, disappointment, fatigue, disorganization, and burnout for both the clinician and the patient. This leads to a sense of failure and a feeling that nothing can be done by office staff, clinicians, and patients. Actions, words, and non verbal behavior from all three groups indicate this in one way or another.
Suspect Diabetes Distress in any patient who is not achieving their goals for A1C, LDL B/P or has significant difficulty with self management e.g nutrition, weight, or physical activity.
Start with the DDS2 a 2 question screening test--if the scores are 3 or greater then go to DDS17 a 17 question test. Dr. Fisher cautions that use of the DDS 2 may not be effective and it is of more value to use the full scale or a few sub scales. Although the test can be self administered I find it helpful for it to be administered by the clinician or other Health Care Provider (HCP) to the patient. The DDS 17 is available in English and Spanish. Click here to download the questionnaires and scoring sheet.
If you would like to learn more about Diabetes Distress you can download slides (pdf format) that provide more information by clicking here. After reviewing the slides and you wish to obtain a Diabetes Distress Learning Center Certificate (below) you will need to take a test. The test is set up for you to make 100. Click here to take the test.
The questionnaire can be self administered but I have found it helpful to read the questionnaire with the patient. This provides the opportunity for the patient to expand on their answer and Health Care Practitioner (HCP) can discover more about patient feelings. When the HCP administers the questionnaire this creates trust and strengthening of the bond with the patient. It also provides opportunity to start treatment. Treatment can be started by any member of the office team.
See discussion and articles below for treatment options. Click on the blue underlined word to download the material.
Shahady and O'Grady This article provides a nice summary of how to recognize and treat diabetes distress.
Polonsky W et al,This was the first article to describe the Diabetes Distress Scale DDS17. This article describes the development of the a new instrument for the assessment of diabetes-related emotional distress, based on four independent patient samples. Diabetes Care 2005;28:626–631
L Fisher AASP protocol---personal communication--is a clear and concise program to help HCP deal with diabetes distress, enhance patient performance and reduce drop-out. Excellent hand out to help with orderly treatment of Diabetes Distress
Fisher L et al, Predicting Diabetes Distress. Study identified a list of significant, independent direct and interactive predictors of high DD. Can be used to identify high-risk patient cohort. Because of the impact of high DD on diabetes behavioural and biological indicators, the findings suggest the usefulness of regularly appraising both current life and disease-related stressors in clinical care. Diabet. Med.2009; 26: 622–627
Fisher L et al Depression vs Diabetes Distress in T2 DiabetesMost patients with diabetes and high levels of depressive symptoms are not clinically depressed. The Center for Epidemiological Studies Depression Scale is more reflective of general emotional and diabetes related distress than clinical depression. Most treatment of distress is based on the depression literature. Need to consider different interventions for distressed but not clinically depressed diabetic patients. Diabetes Care 30:542–548, 2007
Fisher et al, Diabetes Distress but Not Clinical Depressionor Depressive Symptoms Is Associated With Glycemic Control The study found no association between Major Depressive Disorder (MDD) or depressive symptoms with A1C, whereas were found between diabetes distress and A1C. What has been called “depression” among type 2 diabetic patients may really be two conditions, Major Depressive Disorder (MDD) and diabetes distress (DD), with only the latter displaying significant associations with A1C. Diabetes Care 2010 33:23–28
Shahady E Podcast Dr. Shahady describes a patient with quality numbers out of control and how he used the Diabetes Distress Questionnaire to help understand how to treat the patient. The link takes you to a web site that requires you to sign in with your email and create a password but it is free .