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. 2022 Jan 13;2:823046. doi: 10.3389/fcdhc.2021.823046

Table 3.

Validity and responsiveness indices for the DSMQ-R scales by study and diabetes type.

Studies DSMQ scales Convergent criteria/outcome variables Correlations (Pearson’s r) with criteria/outcomes Baseline to follow-up changes (Cohen’s d) per scale
T1D T2D T1D T2D
Study 1: Cross-sectional questionnaire study (2015–16); n=588 PWD (333 with T1D, 255 with T2D) 20-item total score HbA1c -0.57‡ -0.36‡ n/a n/a
Ketoacidosis past year (yes) -0.22‡ n/a
With complications2 (yes) -0.17† -0.20†
Treatment satisfaction (DTSQ score) 0.63‡ 0.53‡
Treatment motivation (DAS subscale) 0.68‡ 0.56‡
Treatment neglect (DAS subscale) -0.77‡ -0.68‡
Diabetes distress (PAID-5 score) -0.42‡ -0.27‡
Depressive symptoms (PHQ-9 score) -0.49‡ -0.43‡
27-item total score1 HbA1c -0.57‡ -0.49‡ n/a n/a
Ketoacidosis past year (yes) -0.21† n/a
With complications2 (yes) -0.17† -0.25*
Treatment satisfaction (DTSQ score) 0.64‡ 0.53‡
Treatment motivation (DAS subscale) 0.71‡ 0.61‡
Treatment neglect (DAS subscale) -0.76‡ -0.69‡
Diabetes distress (PAID-5 score) -0.47‡ -0.40‡
Depressive symptoms (PHQ-9 score) -0.53‡ -0.48‡
Eating behavior HbA1c -0.43‡ -0.31‡ n/a n/a
Medication taking HbA1c -0.55‡ -0.42‡ n/a n/a
Glucose monitoring HbA1c -0.53‡ -0.15* n/a n/a
Physical activity BMI -0.10 -0.28‡ n/a n/a
Cooperation with diabetes team Self-reported n of diabetologist visits past year 0.14* 0.09 n/a n/a
Study 2: ‘Depression and Diabetes Control Trial’ (2016–17), prospective randomized trial, retest after six months n=198 PWD (131 with T1D, 67 with T2D) 20-item total score HbA1c -0.36‡ -0.30* Total sample: 5.8 ±1.9 to 6.8 ±1.5‡ (d=0.66). EG: 6.0 ±1.8 to 6.8 ±1.6† (d=0.50), CG: 5.7 ±1.9 to 6.8 ±1.4‡ (d=0.82), p (time*group)=0.66 Total sample: 5.3 ±1.5 to 6.1 ±1.6† (d=0.51). EG: 5.2 ±1.3 to 5.9 ±1.5† (d=0.51), CG: 5.8 ±1.9 to 6.8 ±1.5‡ (d=0.53), p (time*group)=0.89
Summary of diabetes self-care activities past week (SDSCA total score) 0.76‡ 0.77‡
Often failing with diabetes routine (DDS item 8) -0.69‡ -0.54‡
Diabetes distress (PAID score) -0.28‡ -0.24*
Diabetes acceptance (DAS score) 0.51‡ 0.40†
Depressive symptoms (PHQ-9 score) -0.28† -0.22
27-item total score1 HbA1c -0.39‡ -0.32* Total sample: 5.8 ±1.9 to 6.9 ±1.4‡ (d=0.72). EG: 6.0 ±1.8 to 6.9 ±1.5‡ (d=0.59), CG: 5.6 ±2.0 to 6.9 ±1.4‡ (d=0.85), p (time*group)=0.49 Total sample1: 5.6 ±1.6 to 6.4 ±1.6† (d=0.57). EG: 5.3 ±1.1 to 6.5 ±1.2‡ (d=1.44), CG: 6.1 ±2.1 to 6.2 ±2.1 (d=0.06), p (time*group)=0.15
Summary of diabetes self-care activities past week (SDSCA total score) 0.73‡ 0.76‡
Often failing with diabetes routine (DDS item 8) -0.70‡ -0.49‡
Diabetes distress (PAID score) -0.31‡ -0.05
Diabetes acceptance (DAS score) 0.51‡ 0.33*
Depressive symptoms (PHQ-9 score) -0.31‡ -0.13
Eating behavior HbA1c -0.34‡ -0.01 Total sample: 5.0 ±2.2 to 5.7 ±1.9† (d=0.37). EG: 5.2 ±2.3 to 5.8 ±2.1 (d=0.30), CG: 4.9 ±2.2 to 5.7 ±1.8* (d=0.42), p (time*group)=0.93 Total sample: 3.9 ±1.8 to 5.0 ±1.8† (d=0.59). EG: 3.7 ±1.8 to 4.6 ±1.8† (d=0.51), CG: 4.3 ±2.0 to 5.9 ±1.8* (d=0.71), p (time*group)=0.68
Healthy eating past week (SDSCA General Diet scale) 0.67‡ 0.65‡
Not sticking to a good meal plan (DDS item 12) -0.57‡ 0.54‡
Medication taking HbA1c -0.43‡ -0.36† Total sample: 7.8 ±2.7 to 8.8 ±1.8‡ (d=0.47). EG: 7.9 ±2.6 to 8.8 ±1.8* (d=0.43), CG: 7.7 ±2.9 to 8.8 ±1.9† (d=0.49), p (time*group)=0.74 Total sample: 8.0 ±2.5 to 8.6 ±2.1‡ (d=0.27). EG: 7.9 ±2.5 to 8.4 ±2.2 (d=0.23), CG: 8.3 ±2.5 to 9.0 ±1.9 (d=0.28), p (time*group)=0.51
Self-reported n of daily insulin injections 0.27† -0.14
Glucose monitoring HbA1c -0.29† -0.39† Total sample: 5.5 ±3.4 to 7.3 ±2.5‡ (d=0.61). EG: 5.6 ±3.3 to 7.0 ±2.7† (d=0.48), CG: 5.3 ±3.5 to 7.5 ±2.4‡ (d=0.73), p (time*group)=0.20 Total sample: 5.3 ±3.6 to 6.9 ±3.0‡ (d=0.64). EG: 4.7 ±3.6 to 6.6 ±3.0‡ (d=0.78), CG: 6.8 ±3.5 to 7.8 ±3.1* (d=0.39), p (time*group)=0.90
SMBG past week (SDSCA Blood Sugar Testing scale) 0.59‡ 0.81‡
Not testing sugar frequently enough (DDS item 6) -0.74‡ -0.69‡
Self-reported n of daily SMBG checks 0.36‡ 0.61‡
Physical activity BMI -0.05 -0.35† Total sample: 5.1 ±3.0 to 5.4 ±3.0 (d=0.13). EG: 5.2 ±2.7 to 5.5 ±2.8 (d=0.12), CG: 4.9 ±3.3 to 5.3 ±3.3 (d=0.19), p (time*group)=0.99 Total sample: 4.2 ±2.4 to 3.9 ±2.6 (d=0.10). EG: 4.2 ±2.3 to 4.2 ±2.7 (d=0.00), CG: 4.4 ±2.7 to 3.2 ±2.1 (d=0.37), p (time*group)=0.23
Physical exercise past week (SDSCA Exercise scale) 0.73‡ 0.72‡
Cooperation with diabetes team Self-reported n of diabetologist visits past half year 0.20* 0.35† Total sample: 7.9 ±2.3 to 8.5 ±1.7* (d=0.28). EG: 8.0 ±2.3 to 8.5 ±1.9 (d=0.22), CG: 7.8 ±2.4 to 8.4 ±1.5 (d=0.28), p (time*group)=0.89 Total sample: 8.1 ±2.1 to 8.1 ±2.1 (d=0.00). EG: 8.1 ±1.8 to 8.3 ±1.8 (d=0.11), CG: 8.1 ±2.7 to 7.7 ±2.7 (d=0.17), p (time*group)=0.35
Not having a diabetes doctor (DDS item 15) -0.30† -0.57‡
Study 3: Five-year FU of the DIAMOS-ECCE HOMO cohort (2017–18), cross-sectional study n=298 PWD (191 with T1D, 107 with T2D) 20-item total score HbA1c -0.41‡ -0.34‡ n/a n/a
Often failing with diabetes routine (DDS item 8) -0.64‡ -0.72‡
Diabetes distress (PAID score) -0.32‡ -0.34‡
Diabetes acceptance (DAS score) 0.65‡ 0.61‡
Depressive symptoms (PHQ-9 score) -0.24† -0.21*
27-item total score1 HbA1c -0.42‡ -0.24* n/a n/a
Often failing with diabetes routine (DDS item 8) -0.61‡ -0.67‡
Diabetes distress (PAID score) -0.26‡ -0.29†
Diabetes acceptance (DAS score) 0.63‡ 0.57‡
Depressive symptoms (PHQ-9 score) -0.21† -0.26*
Eating behavior HbA1c -0.29‡ -0.35‡ n/a n/a
Not sticking to a good meal plan (DDS item 12) 0.50‡ 0.54‡
Medication taking HbA1c -0.36‡ -0.35‡ n/a n/a
Self-reported n of daily insulin injections 0.01 0.06
Glucose monitoring HbA1c -0.36‡ -0.23* n/a n/a
Not testing sugar frequently enough (DDS item 6) -0.67‡ -0.72‡
Self-reported n of daily glucose checks/scans/ readings 0.33‡ 0.39‡
Physical activity BMI -0.26‡ -0.25* n/a n/a
Cooperation with diabetes team Not having a diabetes doctor (DDS item 15) -0.31‡ -0.14 n/a n/a
Study 4: ‘DIA-LINK1’ (2019–20), prospective observational study, retest after three months n=203 PWT1D 20-item total score HbA1c -0.29‡ n/a 5.8 ±1.7 to 6.4 ±1.5‡ (d=0.38) n/a
Not giving diabetes as much attention as one should (T1-DDS item 28) -0.61‡ n/a
Diabetes distress (PAID score) -0.27‡ n/a
Diabetes acceptance (DAS-10 score) 0.40‡ n/a
Depressive symptoms (CES-D score) -0.32‡ n/a
Feeling guilty for neglecting diabetes treatment (mean of daily EMA ratings) -0.42‡ n/a
Feeling overwhelmed by diabetes treatment (mean of daily EMA ratings) -0.23† n/a
Mean sensor glucose (4 weeks) -0.30‡ n/a
Time-below-range (<70 mg/dl) -0.06 n/a
Time-in-range (70–180 mg/dl) 0.31‡ n/a
Time-above-range (>180 mg/dl) -0.27‡ n/a
Glucose variability (CV) -0.27‡ n/a
27-item total score1 HbA1c -0.33‡ n/a 6.1 ±1.7 to 6.6 ±1.4‡ (d=0.37) n/a
Not giving diabetes as much attention as one should (T1-DDS item 28) -0.61‡ n/a
Diabetes distress (PAID score) -0.29‡ n/a
Diabetes acceptance (DAS-10 score) 0.41‡ n/a
Depressive symptoms (CES-D score) -0.33‡ n/a
Feeling guilty for neglecting diabetes treatment (mean of daily EMA ratings) -0.44‡ n/a
Feeling overwhelmed by diabetes treatment (mean of daily EMA ratings) -0.24† n/a
Mean sensor glucose (4 weeks) -0.33‡ n/a
Time-below-range (<70 mg/dl) -0.04 n/a
Time-in-range (70–180 mg/dl) 0.34‡ n/a
Time-above-range (>180 mg/dl) -0.30‡ n/a
Glucose variability (CV) -0.28‡ n/a
Eating behavior HbA1c -0.08 n/a 4.6 ±2.2 to 5.2 ±1.9‡ (d=0.35) n/a
Not eating as carefully as one should (T1-DDS item 2) -0.55‡ n/a
Feeling that eating is out of control (T1-DDS item 23) -0.48‡ n/a
Medication taking HbA1c -0.36‡ n/a 7.6 ±2.5 to 8.2 ±2.4† (d=0.25) n/a
Time-in-range (70–180 mg/dl) 0.33‡ n/a
Not taking as much insulin as one should (T1-DDS item 8) -0.45‡ n/a
Self-reported n of daily insulin injections 0.22† n/a
Glucose monitoring HbA1c -0.42‡ n/a 6.1 ±2.7 to 6.8 ±2.3‡ (d=0.29) n/a
Time-in-range (70–180 mg/dl) 0.36‡ n/a
Not checking glucose level as often as one should (T1-DDS item 12) -0.70‡ n/a
Self-reported n of daily glucose checks/scans/ readings 0.40‡ n/a
Physical activity BMI -0.15* n/a 5.5 ±3.2 to 5.6 ±3.0 (d=0.04) n/a
Cooperation with diabetes team Can’t tell diabetes doctor what is on mind (T1-DDS item 7) -0.27‡ n/a 8.1 ±2.2 to 8.3 ±1.9 (d=0.11) n/a
Diabetes doctor doesn’t understand what it’s like to have diabetes (T1-DDS item 18) -0.20† n/a
Study 5: ‘DIA-LINK2’ (2020–21), prospective observational study, retest after three months n=180 PWT2D 20-item total score HbA1c n/a -0.20† n/a 5.4 ±1.9 to 6.4 ±1.8‡ (d=0.54)
Often failing with diabetes routine (DDS item 8) n/a -0.40‡
Diabetes distress (PAID score) n/a -0.33‡
Diabetes acceptance (DAS-10 score) n/a 0.46‡
Depressive symptoms (CES-D score) n/a -0.23†
Feeling guilty for neglecting diabetes treatment (mean of daily EMA ratings) n/a -0.43‡
Self-rated quality of self-management overall (mean of daily EMA ratings) n/a 0.47‡
27-item total score1 HbA1c n/a -0.25† n/a 5.8 ±1.9 to 6.9 ±1.7‡ (d=0.61)
Often failing with diabetes routine (DDS item 8) n/a -0.43‡
Diabetes distress (PAID score) n/a -0.39‡
Diabetes acceptance (DAS-10 score) n/a 0.54‡
Depressive symptoms (CES-D score) n/a -0.37‡
Feeling guilty for neglecting diabetes self- management (mean of daily EMA ratings) n/a -0.37‡
Self-rated quality of self-management overall (mean of daily EMA ratings) n/a 0.44‡
Eating behavior HbA1c n/a -0.08 n/a 4.2 ±2.3 to 5.6 ±2.3‡ (d=0.61)
Not sticking to a good meal plan (DDS item 12) n/a -0.53‡
Diet promoting good glucose control (EMA ratings) n/a 0.44‡
Diet beneficial for weight (EMA ratings) n/a 0.46‡
Medication taking HbA1c n/a -0.22† n/a 7.4 ±3.0 to 8.1 ±2.3† (d=0.26)
Self-reported n of daily insulin injections n/a 0.00
Medical diabetes treatment appraisal (EMA ratings) n/a 0.33‡
Glucose monitoring HbA1c n/a -0.08 n/a 5.3 ±3.2 to 6.8 ±2.8‡ (d=0.50)
Not testing sugar frequently enough (DDS item 6) n/a -0.57‡
Self-reported n of daily glucose checks/scans/readings n/a 0.41‡
Physical activity Level of physical activity contributing to good diabetes management (EMA ratings) n/a 0.58‡ n/a 4.1 ±3.1 to 5.1 ±3.0‡ (d=0.36)
BMI n/a -0.31‡
HbA1c n/a -0.15*
Cooperation with diabetes team Not having a doctor for diabetes (DDS item 15) n/a -0.39‡ n/a 8.2 ±1.9 to 8.1 ±1.9 (d=0.05)

Displayed are criterion-related correlations and indices of change (Cohen’s d) from baseline to 6-month follow-up for each DSMQ-R scale stratified by study and diabetes type.

Indication of two-tailed significance: *p < 0.05, †p < 0.01, ‡p < 0.001.

BMI, body mass index; CES-D, Center for Epidemiologic Studies Depression Scale; CG, control group; CV, coefficient of variation; DAS, Diabetes Acceptance Scale; DDS, Diabetes Distress Scale; DM, diabetes mellitus; DTSQ, Diabetes Treatment Satisfaction Questionnaire; EG, experimental group; EMA, ecological momentary assessment; HbA1c, glycated hemoglobin; iscCGM, intermittently scanned continuous glucose monitoring; MDI, multiple daily (insulin) injections; n/a, not available; PAID, Problem Areas in Diabetes Scale; PHQ-9, Patient Health Questionnaire-9; PWD, people with diabetes; rtCGM, real-time continuous glucose monitoring; SDSCA, Summary of Diabetes Self-Care Activities; SMBG, self-monitoring of blood glucose; T1-DDS, Type 1 Diabetes Distress Scale; T1D, type 1 diabetes; T2D, type 2 diabetes.

1The 27-item total score, including the optional items 21–27 regarding intensive insulin treatment, was calculated for corresponding subgroups only [=full T1D group and those with T2D using bolus insulin and multiple daily insulin injections (MDI)].

2Assessed were diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, diabetic foot syndrome.