T2-DDAS: The Type 2 Diabetes Distress Assessment System

THE CORE DISTRESS SCALE

At the heart of diabetes distress is its emotional component, and that's what CORE DISTRESS SCALE measures; that is, how much overall emotional distress due to diabetes the respondent is experiencing. The CORE DISTRESS SCORE is simply the average of the 8 items of the CORE SCALE, with each item rated on a 1 to 5 scale:

  • Mean score < 2.0 indicate little or no distress.

  • Mean score between 2.0 and 2.9 indicate moderate distress.

  • Mean score > 3.0 indicate high distress

Any score > 2.0 is considered clinically significant.

THE SOURCES SCALE

Whether CORE DISTRESS is high or low, it is helpful to identify those aspects of living with diabetes that are contributing to the individual's diabetes distress. The Sources Scale portion of the T2-DDAS measures seven common, specific SOURCES of distress (21 items in total):

  1. Management Demands: Disappointment with one's self-care efforts (for example, “It frustrates me that my eating often feels out of control”).

  2. Hypoglycemia: Concerns about severe hypoglycemic events (for example, “I worry a lot that I could have a serious low glucose event”).

  3. Interpersonal issues: Disappointment that one is not getting the right type of support and help from family and friends about diabetes (for example, “When it comes to family and friends, it disappoints me that I am pretty much on my own with diabetes”).

  4. Healthcare provider: Disappointment with one's current health care professionals (for example, “It upsets me that I'm not really heard or understood by my healthcare provider”).

  5. Shame/Stigma: Concerns about the negative judgments of others (for example, “It upsets me that people in my life think less of me because I have diabetes”).

  6. Long-Term Health: Concerns about the potential harm that diabetes may cause over time (for example, “No matter what I do, I fear that serious complications from diabetes will happen to me”).

  7. Healthcare Access: Concerns that obtaining the medical care one needs for diabetes are, or will be, too difficult (for example, “I worry that I won't be able to pay for my diabetes care, medicines, or supplies”).

Each of the distress SOURCES is simply the average of the 3 items in each of the scales, with each item rated on a 1 to 5 scale:

  • Mean score < 2.0 indicate little or no distress.

  • Mean score between 2.0 and 2.9 indicate moderate distress.

  • Mean score > 3.0 indicate high distress

Any subscale score > 2.0 is considered clinically significant.

How to Use the T2-DDAS

Use the T2-DDAS to identify three levels of specificity of diabetes distress information for use in clinical care:

  1. Use the CORE score as a way to begin a conversation about a patient's overall level of diabetes distress and current general feelings about living with diabetes.

  2. Review each of the 7 SOURCE scores to identify the highest reported source or cause of distress. Use this subscale to begin a conversation about more focused areas of concern.

  3. Identify the highest rated of the 28 T2-DDAS items. Use these specific items to begin a conversation about particular sources of diabetes distress.

How to use the T2-DDAS on This Website

You can download a copy of the T2-DDAS in English or Spanish, along with scoring instructions.

You may also ask patients to complete the T2-DDAS in English or Spanish online. Online administration will produce a single CORE score, 7 SOURCES scores, and all item scores, which will be computed automatically. All scores will then be summarized in an accompanying report, available for download or printing.

CAUTIONS

The resulting T2-DDAS report can be copied and pasted into an electronic health record.

If the patient completes the T2-DDAS on a phone or tablet, however, the report cannot be copied and pasted directly into another device. Please email the report from a phone or tablet to a desk or laptop to complete the copy-paste function.

TO PROTECT PATIENT CONFIDENTIALITY, PLEASE NOTE THAT NO T2-DDAS ITEM OR SUMMARY REPORT DATA WILL BE RETAINED OR STORED ONCE THE RESPONDENT LEAVES THE WEBSITE!