Clinically-meaningful cut-points for diabetes distress among adolescents with type 1 diabetes

A new publication from the ACBRD highlights the high proportion of adolescents with type 1 diabetes who experience clinically-significant diabetes distress.

by Virginia Hagger


Studies in adults have reported high levels of emotional distress related to living with type 1 and type 2 diabetes. Diabetes distress characterises the ongoing emotional burden of managing diabetes, including feelings of frustration, worry and helplessness. The prevalence of diabetes distress among adolescents was previously uncertain, due to the absence of validated cut-points for age-appropriate measures.

This study by ACBRD researchers Virginia Hagger, Dr Christel Hendrieckx, Prof Jane Speight, and colleagues recently published in Diabetes Care, included 537 adolescents aged 13 to 19 years, who took part in the national Diabetes MILES Youth survey. Diabetes distress was measured with the Problem Areas in Diabetes-Teen (PAID-T), a brief questionnaire reflecting diabetes-related concerns specific to adolescents’ age and life-stage. The relationships between the PAID-T and depressive symptoms, self-reported HbA1c and self-monitoring of blood glucose (SMBG), were examined in order to establish clinically meaningful cut-points for diabetes distress.

Two cut-points were found to distinguish between three levels of severity: none-to-mild (<70), moderate (70–90), and high (>90) diabetes distress. Over half of the adolescents reported at least moderate distress (18% moderate; 36% high distress). Compared to adolescents with none-to-minimal distress, those with greater distress had significantly higher self-reported HbA1c and more severe depressive symptoms, and performed SMBG less frequently.

Using these cut-points, clinicians and researchers will now be able to identify young people who could potentially benefit from self-management support and enable evaluation of interventions aimed at reducing diabetes distress.

Hagger V, Hendreickx C, Cameron F, Pouwer F,  Skinner T, Speight J. Cut Points for Identifying Clinically Significant Diabetes Distress in Adolescents With Type 1 Diabetes Using the PAID-Teen: Results From Diabetes MILES Youth–Australia. Diabetes Care; doi.org/10.2337/dc17-0441

The Diabetes MILES Youth Study was funded by the National Diabetes Services Scheme, an initiative of the Australian Government, administered with the support of Diabetes Australia.

The Centre publishes a peer-reviewed journal article from the MILES Youth study in Diabetes Care.

by Virginia Hagger


Despite the challenges of type 1 diabetes, most adolescents adapt well to living with this chronic condition. Research commonly focuses on those at high risk and with sub-optimal clinical and psychological outcomes, but we can also learn from youth coping well with diabetes.

In a study published recently in Diabetes Care, Assistant Professor Marissa Hilliard (Baylor College, Texas) and colleagues investigated strengths and resilience among 471 young people (between 13 and 19 years), who took part in the Diabetes MILES Youth Study. ‘MILES Youth’ was a national survey, and a collaboration between the ACBRD (Virginia Hagger, Dr Christel Hendrieckx, Dr Steven Trawley and Prof Jane Speight) and several other researchers and paediatric clinicians in Australia, the USA and The Netherlands.

Diabetes strengths and resilience were measured with the DSTAR-Teen, a self-report measure of adaptive attitudes and behaviours related to living with type 1 diabetes, developed by A/Prof Hilliard. The study results show that greater diabetes strengths are associated with more frequent self-monitoring of blood glucose (SMBG), lower self-reported HbA1c and higher general quality of life (QoL). Adolescents with greater diabetes strengths also experience fewer depressive and anxiety symptoms and less diabetes-related family conflict. All three resilient outcomes (SMBG frequency ≥4 checks per day; HbA1c <7.5%; and general QoL rating ≥7/10) were achieved by 27% of the study participants.

These findings among Australian youth support previous research showing that young people with stronger coping and support strategies are more likely to have optimal diabetes self-management and psychological wellbeing. Building on these strengths may help young people to overcome diabetes challenges. Research investigating the outcomes of resilience-oriented interventions is emerging.

Hilliard M, Hagger V, Hendrieckx C, Anderson B, Trawley S, Jack M, Pouwer F, Skinner T, Speight J.Strengths, Risk Factors, and Resilient Outcomes in Adolescents With Type 1 Diabetes: Results From Diabetes MILES Youth–Australia. Diabetes Care, 2017; 40(7): 849-855.

The Diabetes MILES Youth Study was funded by the National Diabetes Services Scheme, an initiative of the Australian Government, administered with the support of Diabetes Australia.