b'VA Clinicians Tackle Issue of Defining and Combating Diabetes DistressPatients Struggle With Ill Health, Demanding Care RegimensDiabetes, which can cause numerous adverse issues and shorten life, often requires chronic and demanding self-management. Manypatients suffer emotionally because of that. VA clinicians noware focusing on the problem of diabetes distress anddeveloping new ways to measure and respond to it.By LaTina EmersonHOUSTONThe term diabetes distress is usedIn patients with Type 2 diabetes, reducing hemoglo-to describe the emotional response to living withbin A(HbA ) levels has been found to lower mor-1c 1cdiabetes,alife-threateningillnessthatrequiresbidity and mortality. Since diabetes is a chronic condi-chronic and demanding self-management. It alsotion, continued reduction of HbArequires patient 1ctakesintoaccountotherproblemsdiabetespa- activation,commitmenttotreatmentplanningand tients face, including lack of social support, a poorself-management, the report suggested. relationship with their physician or difficulty ac- Lifestyle changes that are required to manage dia-cessing healthcare. betes may carry an emotional burden that contrib-Now,anewstudyhassuggestedvaluesthatareutes to diabetes-associated distress, which refers to associated with clinically important improvements inthe worries, fears and threats arising from struggles diabetes distress, which could improve overall carewith chronic diabetes care (i.e., management, com-for diabetes patients. plicationsandlossoffunction)andisassociated When treating diabetes patients, the healthcare fieldwith changes in HbAlevels, according to the arti-1chas lacked established minimal clinically importantcle. Patients with high distress have significantly difference (MCID) values for the Diabetes Distresshigher HbAlevels and are less likely to maintain 1cScale-17 (DDS-17), a common measure of diabetesblood glucose levels within the reference range, the distress, the study authors explained.authors explained.ThestudypublishedinJAMANetworkOpenwasThe DDS-17 is an established measure with 17 items designed to establish a distribution-based metric fortoassessthelevelofdistressindiabetespatients. MCIDintheDDS-17anditsfoursubscalescoresHigher DDS-17 scores are associated with poor life-(interpersonal distress, physician distress, regimen dis- stylechoices,self-management,self-efficacy,self-tress and emotional distress), according to the authors. 1 care, and adherence to recommended treatment regi-The study authors were affiliated with the Houstonmens, while lower scores are associated with reduc-CenterforInnovationsinQuality,Effectivenesstions in HbA1c, the authors pointed out. andSafety(IQuESt)attheMichaelE.DeBakeyPreviousDDS-17validationstudieshaverec-VAMC,theUniversityofTexasHealthScienceommendeddistressthresholds,butthecutpoints CenteratHouston,BaylorCollegeofMedicineare limited by their inability to capture significant and University of Houston, all in Houston, and thechanges in DDS-17 scores that do not cross a cut-University of Texas Medical Branch in Galveston. point, they added.59'