Cut Points for Identifying Clinically Significant Diabetes Distress in Adolescents With Type 1 Diabetes Using the PAID-T: Results From Diabetes MILES Youth–Australia

Abstract

Using the PAID-T, this study defined two clinically meaningful cut points to distinguish none-to-mild, moderate, and high diabetes distress in adolescents (aged 13-19). Based on these cut points, most respondents experienced at least moderate diabetes distress, which was clinically significant. Establishing thresholds for elevated diabetes distress will aid clinicians and researchers to interpret PAID-T scores, prompt discussion and intervention for those with unmet needs, and enable the effectiveness of interventions to be evaluated.

Diabetes distress is more strongly associated with HbA1c than depressive symptoms in adolescents with type 1 diabetes: Results from Diabetes MILES Youth-Australia

“…While our study was cross‐sectional, longitudinal studies indicate that individuals who are struggling emotionally with diabetes may be less engaged in self‐management or more likely to engage in suboptimal behaviors, while those who are less attentive to self‐care may feel guilty or frustrated with their diabetes management . Furthermore, our previous analyses have demonstrated a stronger association between HbA1c and PAID‐T items focused on regimen‐related distress than other PAID‐T items . Thus, addressing self‐management difficulties, and the psychological distress associated with these, may be more likely to improve HbA1c than interventions focused on depressive symptoms or diabetes management alone.…”

“…Items are rated on a 6‐point scale: 1 to 2 (not a problem), 3 to 4 (moderate problem), 5 to 6 (serious problem). Scores are summed (range: 26‐156), with higher scores indicating greater diabetes distress; based on recently validated cut‐points, distress can be categorized as none/minimal (26‐69), moderate (70‐90), or high (>90) . Cronbach’s alpha in this sample was .96, indicating very high internal consistency.…”

“…14,26 Furthermore, our previous analyses have demonstrated a stronger association between HbA1c and PAID-T items focused on regimen-related distress than other PAID-T items. 18 Thus, addressing self-management difficulties, and the psychological distress associated with these, may be more likely to improve HbA1c than interventions focused on depressive symptoms or diabetes management alone. Avoidant coping style has been found to predict diabetes distress among adolescents with T1D, which in turn influenced self-care and glycemic control.…”

“…Now that an adolescent‐specific measure of diabetes distress (PAID‐T) has been validated among youth aged 11 to 19 years, the opportunity exists to investigate the interaction between depressive symptoms, diabetes distress, and HbA1c robustly in this age group. Furthermore, clinically meaningful levels of diabetes distress can now be defined through established cut‐points . Therefore, the aim of this study, among adolescents with T1D, was to examine the interaction between depressive symptoms and diabetes distress and HbA1c, and to determine the extent to which severity of depressive symptoms and diabetes distress explain the variance in HbA1c.…”

“…Furthermore, clinically meaningful levels of diabetes distress can now be defined through established cut-points. 18 Therefore, the aim of this study, among adolescents with T1D, was to examine the interaction between depressive symptoms and diabetes distress and HbA1c, and to determine the extent to which severity of depressive symptoms and diabetes distress explain the variance in HbA1c.…”