Introducing the PAID-11, a brief measure of diabetes distress

In this paper, an 11-item Problem Areas in Diabetes scale (PAID) scale for adults with type 1 diabetes is proposed from the UK DAFNE dataset

by Dr Shikha Gray

Diabetes distress refers to the emotional burden of living with diabetes. It involves feeling overwhelmed by the demands of self-management, and can manifest as anger, guilt, shame, worries and frustrations about living with diabetes. The extent to which people experience diabetes distress varies based on their age, sex, type of diabetes, how they manage it, and many other factors. It is important for health professionals to be alert to the possibility of diabetes distress in the people they support. Doing so can help practitioners develop a more empathic approach, which is associated with better clinical outcomes, and inform clinical decisions by providing crucial context for their patients’ barriers to self-care.

How is diabetes distress assessed?

Diabetes distress can be assessed during the course of routine clinical conversations. However, research shows that diabetes health professionals often lack the time and confidence to ask about mental health. As a result, many people with diabetes are never or rarely asked about how they are coping with their condition. Questionnaires are a pragmatic, efficient and systematic way of assessing diabetes distress in clinical practice. The most widely used questionnaire for diabetes distress is the 20-item Problem Areas in Diabetes scale (PAID). Although this is relatively quick to use, clinicians typically want briefer measures but the PAID-5 and PAID-1 may be too brief to be useful clinically.

Latest research: PAID-11 for adults with type 1 diabetes

Recently, a team of researchers, including Professor Jane Speight, conducted a study to establish whether the original 20-item PAID questionnaire could be shortened. They used data from 1,547 adults with type 1 diabetes (T1D) from the UK DAFNE (Dose Adjustment for Normal Eating) structured T1D education programme. Using statistical methods, the researchers reduced the original 20-item PAID to a select 11 items. Doing so did not diminish the reliability, predictive validity, convergent validity and responsiveness of the questionnaire.

In conclusion, PAID-11 was validated as a quick and easy measure of diabetes distress in adults with T1D. The adoption of the questionnaire by health professionals may facilitate productive conversations with people with diabetes and, in turn, lead to improved support for emotional health.

To read more about research in this area, check out our other blogs on diabetes distress, mental health and clinical practice.

Stanulewicz N, Mansell P, Cooke D, Hopkins D, Speight J & Blake H. PAID-11: A brief measure of diabetes distress validated in adults with type 1 diabetes. Diabetes Research and Clinical Practice. 2019;

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