Study On The Psychometric Properties Of The Chinese Version Of The Diabetes Distress Scale In Elderly Group And Its Correlation With TCM Syndrome

Objective:To evaluate the reliability and validity of the Chinese version of Diabetes Distress Scale(C-DDS)in elderly T2 DM population and explore the relationship among diabetic distress,physical and chemical indexes and TCM syndrome of diabetes mellitus.Methods:The cross-sectional non-intervention study is conducted from October 2017 to May 2018 when the patients in the Department of Endocrinology,affiliated Hospital of Chengdu University of TCM are randomly chosen.C-DDS collects their psychological characteristics.The reliability and validity of the scale are assessed by Cronbach’s α and factor analysis,respectively.The clinical data and TCM dialectical classification are collected by self-made clinical and TCM syndrome information collection form.The patients are divided into distress group and non-distress group according to C-DDS score,One-way ANOVA and independent sample T-Test aim to analysis its correlation with clinical indexes and TCM syndrome.Results:1.The measurement about the psychometric properties of scale(1)The reliability of the C-DDS 17: The Cronbach’s α of the CDDS-17 is 0.82,The Cronbach’s α increases to 0.823 and 0.829,respectively after excluding item 5 and 12.The CITC value is 0.290 and 0.163.Therefore,the two items are not statistically worth retaining.(2)Item analysis: the significance of all items is less than 0.05 according to the extreme group test method,and the ITC of item 12,7,17 is less than 0.4 by the way of item-total correlation.(3)Validity test: Four factors are extracted to explain 54.621% of the total variance of the original item variables.Factor 1 consists of five items(item 1,3,8,11,and 14),factor 2 is composed of also five items(item 2,4,9,6 and 10),factor 3 includes four items(item 7,13,17 and 16),factor 4 contains two items(5 and 12),and item 15 is invalid.(4)After the comprehensive analysis of the remaining items without item 5,12 and 15,three interpretable factors are chosen which takes up 54.97% of the scale variance.The Cronbach’s α of the total scale and the three subscales is 0.832,0.791,0.717 and 0.665,respectively.2.Patients are divided into distress group and non-distress group in terms of the scale score.For total score:(1)There is no significant difference in terms of sex,educational level,exercise, diet control,smoking history,medication use,frequency of hypoglycemia during the latest month and complications between the two groups.(2)Distress group has the lower H-DLC statistically significant compared with non-distress group(P≤0.05),however,the remaining are not statistically significant.For subscale score:Waist circumference,BMI,TG,age,FPG and HbA1 c are statistically different among sub-scale groups.3.Patients are divided into five groups by the TCM syndrome and compared among groups.(1)46 cases about Yin deficiency and excessive heat syndrome;55 cases about dampness,heat trapped spleen syndrome;59 cases about Qi-Yin deficiency syndrome;12 cases about syndrome of Yin-yang deficiency,blood stasis and water retention;and 14 cases about blood stasis syndrome.(2)There is no significant difference in the scores of the scales among the types of syndromes.(3)Yin-Yang deficiency and blood stasis-water retention group has the longest duration of diabetes,which is significantly different from that in the other three groups without dampness,heat trapped spleen syndrome(P <0.05).The value of HbA1 c in Yin-yang deficiency,blood stasis and water retention group is the lowest,and the difference is significant compared with Yin deficiency and excessive heat group,Qi-yin deficiency group and dampness,heat trapped spleen syndrome group.There is no significant difference in terms of age,FPG,TC,H-DLC,L-DLC,UA,ACR,BMI and SCr among the five groups.4.The samples are divided into two groups,A(with stagnation of QI due to depression of the liver)and B(without stagnation of QI owing to depression of the liver).The number of patients with diabetic distress and the scores of the scales in group A is notably higher than that in group B(P < 0.05).Conclusion:1.C-DDS 14 provides a method to measure psychometric properties for elderly patients with type 2 diabetes mellitus in China,and its reliability and validity are generally acceptable,but some items need to be further revised.The relationship between psychological distress of diabetes mellitus and demographics and clinical indicators is in urgent need of a comprehensive evaluation study covering different races,regions and populations.2.The distribution of TCM syndrome in elderly patients with type 2 diabetes is associated with the duration of diabetes,HbA1 c and BMI.The above metrics can be regarded as the reference to the differentiation of TCM syndrome.The score of diabetes distress is remarkably related to the stagnation of QI due to depression of the liver,thus it can be used as a reference factor of that.