What Is a Clinically Meaningful Change in Diabetes Distress? Findings for Diabetes Care and Research From the SFDT1 Cohort

Aims: Diabetes distress (DD) is common and evolves heterogeneously over time. We aimed to estimate minimal clinically important differences (MCID) for the Problem Areas in Diabetes (PAID) scale and its sub-dimensions and to identify predictors of worsening over 1 year in people with type 1 diabetes (PwT1D). Materials and Methods: MCIDs for PAID total and sub-dimension scores were derived using the standard error of measurement approach. One-year DD worsening, stability and improvement were defined using the ±1 MCID threshold. We analysed changes in DD using data from the SFDT1 cohort. Logistic regression models identified predictors of worsening for PAID total and sub-dimensions, adjusting for baseline DD, age, sex and social vulnerability. Results: We analysed data from 2457 adults with type 1 diabetes (51.6% female, 41.3 years old (SD 14.0), 23.7 years diabetes duration (SD 14.0)). The MCID for PAID total was 5.0 points, with sub-scale MCIDs ranging from 8.5 (emotional distress) to 14.3 points (management distress). Over 1 year, 42% experienced clinically meaningful worsening of total DD, 30% improved and 28% remained stable. Worsening of total PAID was associated with social vulnerability, HbA1c increase and treatment burden. Distress trajectories varied across sub-dimensions, with emotional distress and burnout most frequently worsening (34% each); initiation of automated insulin delivery was solely associated with lower odds of worsening on the burnout dimension. Conclusions: This study provides MCID values for the PAID scale and its sub-dimensions. The high temporal variability observed suggests a need for regular monitoring and clinically informed assessment of DD in PwT1D.