The Need For Development Of A Modified Diabetes Distress Scale (Mdds) In India: A Cross-Sectional Study Of Its Clinical Relevance

Abstract

Background: Diabetes distress refers to the negative emotional impact of living with diabetes, including concerns related to self-management, complications, healthcare interactions, and social situations. It is not a psychiatric disorder but a stress response to the ongoing demands of diabetes care. In India, limited data are available focusing exclusively on diabetes distress, despite evidence that it significantly influences treatment outcomes and adherence. Although screening for diabetes distress has been recommended, it remains largely underdiagnosed in routine clinical practice. This study aimed to describe the development of a modified Diabetes Distress Scale (mDDS), distinct from the existing DDS-17, incorporating culturally relevant factors, and to assess the prevalence of diabetes distress among adults with type 1 and type 2 diabetes. The study also examined the relationship between distress levels, glycemic control, and treatment compliance, with particular attention to patients reporting low distress scores.

Subjects and Methods:This prospective, cross-sectional observational study included 300 adult patients with type 1 and type 2 diabetes recruited from two tertiary care centers in Bhagalpur and Mumbai. Participants were enrolled using a non-probability convenience sampling method after obtaining written informed consent. Data were collected through interviewer-administered questionnaires using the 20-item modified Diabetes Distress Scale (mDDS), which assesses emotional burden, physician-related distress, regimen distress, interpersonal distress, and socio-religious stressors. A total distress score of 25 was considered the cut-off for minimal distress. HbA1c values were recorded to objectively assess glycemic control and compliance.

Results:Participants had a mean age of 45 ± 13.3 years, a mean diabetes duration of 3.2 years, and a mean HbA1c of 9.2 ± 2.1%. The mean baseline mDDS score was 30 ± 0.6, indicating overall low distress. Based on total scores, 55% of participants reported minimal distress (<25), 36% had moderate distress (46-70), and 9% had high distress (71-100), which was statistically significant (p < 0.001). Notably, 32% of individuals classified as having minimal distress had HbA1c values greater than 10%, suggesting poor treatment compliance, unhealthy lifestyle practices, or disengagement from diabetes care rather than true emotional well-being.

Conclusion:This study demonstrates the clinical utility of the modified Diabetes Distress Scale (mDDS) in identifying culturally relevant dimensions of diabetes-related distress in Indian patients. Importantly, low reported distress did not consistently indicate good compliance or glycemic control, highlighting the need to assess emotional disengagement and denial in diabetes management. Incorporating mDDS into routine clinical practice may aid in identifying hidden psychosocial barriers, guiding targeted psychological interventions, and improving overall diabetes care outcomes.