Diabetes related distress (DRD) is usual for patients with type 2 diabetes (T2D), which worsens glycemic control through negative effects on well-being and self-care behaviors. Diabetes Distress Scale (DDS) is a globally-used instrument to measure DRD. The aim of this study was to validate the Japanese version of the DDS (DDS-J) and to identify the characteristics of individuals at high risk for DRD.

DDS-J was developed conceptually equivalent to the original version through an appropriate process. A cross-sectional study was conducted in 206 T2D patients (mean age 64.1 years, 62.1% male, mean duration 13.2 years, mean HbA1c 7.6%) at outpatient department of 2 hospitals in Aichi, Japan from February to May 2018. Cronbach's α and test-retest method were used to assess reliability, and factor analysis to analyze validity. The 5-item WHO Well-Being Index (WHO-5) and Patient Health Questionnaire-9 (PHQ-9) scale were adopted to evaluate the criteria-related validity.

Four factors of regimen-related distress (RD), emotional burden (EB), physician-related distress (PD), and interpersonal distress (ID) were extracted by factor analysis. This factor structure was the same as the original. The overall Cronbach's α was 0.92, while ones for RD, EB, PD, and ID were 0.86, 0.89, 0.75 and 0.82, respectively. Test-retest correlation score was 0.63. The DDS-J score showed a moderate and significant correlation with WHO-5 (r=-0.43, p<0.01) and PHQ-9 (r=0.49, p<0.01). To analyze the variables associated with the DDS-J score, a multiple regression analysis was performed with age, BMI, gender, HbA1c, and injection use as independent variables. HbA1c (slope 3.62, p<0.01) and age (slope -0.28, p<0.01) remained significantly associated with DDS-J score with an R2 of 0.22.

DDS-J showed good validity and reliability, and can be used as an effective tool to assess DRD of Japanese adult T2D patients. Those with higher HbA1c and younger age should be paid attention in terms of DRD.


N. Takami: None. K. Okazaki: Advisory Panel; Self; Eli Lilly and Company. Speaker's Bureau; Self; Abbott, Mitsubishi Tanabe Pharma Corporation, Sanofi. N. Takahashi: None. M. Suematsu: None. W. Ohashi: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.