Diabetes distress screening using PAID-5 and PAID-1 among adults attending a tertiary multidisciplinary type 1 diabetes clinic.

Aims: Living with type 1 diabetes can be challenging, and diabetes distress may be overlooked during time-constrained clinical assessments. Screening for diabetes distress with the one-item Problem Areas in Diabetes Scale (PAID)-1, in conjunction with the five-item PAID-5, may offer an efficient method to improve type 1 diabetes assessment. We aimed to evaluate the utility of this approach to identify possible diabetes distress and its clinically significant covariates.

Methods: We performed a retrospective, real-world, cross-sectional study of adults attending a multidisciplinary type 1 diabetes outpatient clinic at a tertiary centre from October 2023 to September 2024, inclusive. Screening was conducted using PAID-5 (incorporating PAID-1) during the initial consultation.

Results: There were 160 adults included (median age 38 years [IQR 30-52]; type 1 diabetes duration 16 years [4-24]; n = 138 [86%] were using continuous glucose monitoring [CGM]). PAID-5 median score was 8 [4-12]; 83 individuals (52%) had a score ≥8, indicating possible diabetes distress. Higher diabetes distress screening scores were associated with CGM metrics indicative of hyperglycaemia; no associations were observed with CGM-detected hypoglycaemia. PAID-1 had sensitivity 81% and specificity 96% for PAID-5-detected diabetes distress.

Conclusions: A high prevalence of diabetes distress was detected on screening among adults attending a tertiary type 1 diabetes service. This highlights the importance of psychological assessment and implementation of management strategies for diabetes distress to reduce the burden of living with type 1 diabetes. Our findings support the use of the PAID-1 as a rapid screening tool to assess for diabetes distress.