Psychometric evaluation of the Arabic brief forms of the diabetes distress scale in Egyptian patients with type II diabetes.

backgroundDiabetes distress is highly prevalent among patients with type 2 diabetes mellitus (T2DM), and is consistently associated with poor self-care, medication nonadherence, and suboptimal glycemic control, leading to worse outcomes and reduced quality of life. Despite its clinical significance, routine screening is often overlooked in primary care and family medicine settings due to limited time and resources. Brief tools, such as the 2-item (DDS-2) and 4-item (DDS-4) Diabetes Distress Scales, offer practical alternatives to longer measures; however, validated Arabic versions are lacking. Given the high burden of T2DM in the Middle East and North Africa, culturally adapted and reliable screening instruments are necessary. This study evaluated the psychometric properties of the Arabic DDS-2 and DDS-4 among Egyptian patients with T2DM.

methodsA cross-sectional study was conducted with 366 participants recruited from five urban family medicine settings in Port Said, Egypt. Internal consistency was evaluated using Cronbach’s α, and confirmatory factor analysis (CFA) was used to assess the one-factor structure of the Arabic DDS-4. Concurrent, convergent, and predictive criterion validity were assessed by examining correlations between the Arabic DDS-2 and DDS-4 and the 17-item Diabetes Distress Scale (DDS-17), Patient Health Questionnaire-9 (PHQ-9), General Medication Adherence Scale (GMAS), and glycated hemoglobin (HbA1c). Known-group validity was assessed through associations with sociodemographic and clinical characteristics. Criterion validity was evaluated using receiver operating characteristic (ROC) curves, with high diabetes distress defined by the DDS-17 cutoff (≥ 3).

resultsThe Arabic DDS-2 and DDS-4 demonstrated strong internal consistency, with Cronbach’s alpha values of 0.728 and 0.904, respectively. CFA confirmed a one-factor structure for the Arabic DDS-4. The Arabic DDS-2 and DDS-4 showed very strong correlations with the DDS-17 (r = 0.910–0.953, p < 0.001), supporting strong concurrent validity. Both scales demonstrated moderate positive correlations with depressive symptoms (r ≈ 0.53–0.55, p < 0.001) and weak negative correlations with medication adherence (r ≈ − 0.31 to − 0.33, p < 0.001), indicating good convergent validity. Their weak correlations with HbA1c (r ≈ 0.19–0.21, p < 0.001) provided evidence of fair predictive validity. Known-group validity was confirmed by higher distress scores among patients with lower education, physical inactivity, failure to achieve glycemic targets, insulin use, complications, comorbidities, depressive symptoms, and poor medication adherence (all p < 0.05). The area under the curve (AUC) was higher for the DDS-4 (0.958) than for the DDS-2 (0.846), indicating stronger discriminative ability. The DDS-2 achieved excellent specificity (99.6%) and positive predictive value (98.6%), whereas the DDS-4 showed superior sensitivity (95.9%) and negative predictive value (98.9%).

conclusionThe Arabic DDS-2 and DDS-4 are reliable and valid instruments for screening diabetes distress in Arabic-speaking patients with T2DM. Their brevity makes them particularly useful in busy clinical settings, while their psychometric strength supports application in diverse healthcare contexts and research.