b'uFromPage 59Smallest Meaningful ChangeThe researchers said they wanted to overcome theThesefindingscouldimprovecarefordiabetes limitations of the DDS-17 and determine the clini- patients, he added.cal relevance of observed changes by calculatingWe hope that clinicians and patients will use the MCIDs, a numerical score that shows the small- MCIDvalueswecalculatedtoassessresponseto est meaningful change along the range of a con- treatments or interventions surrounding diabetes dis-tinuous measure. tress, Banks said. We also hope that researchers use Inthisstudy,theresearchersusedbaselineandthese values to inform future research examining dia-postintervention data from 248 participants in a ran- betes distress using the DDS-17 scale.domizedclinicaltrialcomparingtheEmpoweringPrior studies that have employed the DDS-17 have PatientsinChronicCare(EPICC)interventionvs.utilized a cutpoint of 2.0 as a dichotomous variable, an enhanced form of usual care (EUC). The partici- with scores greater than or equal to 2.0 signifying pants were adults with uncontrolled Type 2 diabetesthe presence of moderate diabetes distress in partici-(HbA1C level 8.0%) who received primary care inpants, he explained.participating VA clinics across Illinois, Indiana andA limitation of this cutpoint approach, however, is Texas. There were no differences in outcomes basedits inability to capture significant changes in DDS-17 on demographic factors, the researchers pointed out. scores that do not cross this 2.0 cutpoint, according to Participants in EPICC attended six group sessionsBanks, who added that the limitation can be overcome led by healthcare professionals based on collaborativethrough the calculation of MCID values.goal-setting theory. EUC included diabetes education,Distribution-basedMCIDvalueshadnotbeen the authors explained. establishedfortheDDS-17,headvised,noting, The authors calculated distribution-based MCIDWe wished to address this important research gap values for the total DDS-17 and four DDS-17 sub- by calculating the MCIDs for the DDS-17 and each scales,usingthestandarderrorofmeasurement.of its four subscales.They grouped baseline to postintervention changes1Banks J, Amspoker AB, Vaughan EM, Woodard L, Naik AD. Ascer-in DDS-17 and its four subscale scores into threetainment of Minimal Clinically Important Differences in the Diabetes categories:improved,nochangeandworsened.Distress Scale-17: A Secondary Analysis of a Randomized Clini-The research team examined associations betweencal Trial. JAMA Network Open. 2023 Nov 1;6(11):e2342950. doi: 10.1001/jamanetworkopen.2023.42950. PMID: 37966840; PMCID: treatment group and MCID change categories andPMC10652154.whether improvement in HbA1C varied in associa-tion with MCID category.We calculated an MCID value of 0.25 for DDS-17, 0.38 for the emotional and interpersonal distress sub-scales, and 0.39 for the physician and regimen distress subscales, Jack Banks, PhD, a researcher at Michael E. DeBakey VAMC, told U.S. Medicine. Our find-ings suggest that MCID changes of 0.25 or greater on the DDS-17 are associated with clinically important improvements in diabetes distress.In calculating the MCIDs for the DDS-17 and each of its subscales, we now have a measure with the abil-ity to capture meaningful improvements or worsen-ing of diabetes distress that are independent of a cut-point, said Banks, who also is a postdoctoral fellow in the School of Public Health at The University ofA senior diabetic man checks his glucose data on smartphone outdoors.Texas Health Science Center at Houston.Source:Halfpoint/Shutterstock60'