T1-DDS: For adults with type 1 diabetes

The T1-DDS is a 28-item self-report instrument.

Each item is rated on a 6-point scale from (1) “not a problem” to (6) “a very significant problem.”

The scale yields an overall distress score based on average responses along the 1-6 scale for all 28 items (range = 1-6).

The scale also yields a score for each of 7 subscales based on the average response on all of the items in that subscale (range = 1-6).

T1-DDS Total Score

An indicator of overall diabetes distress (average of all 28 items, each rated on a 1 to 6 scale).

7 T1-DDS Sub Scales: Each score is the item average.

  1. Powerlessness: A broad sense of feeling discouraged about diabetes; e.g., “feeling that no matter how hard I try with my diabetes, it will never be |good enough.”
  2. Management Distress: Disappointment with your self-care efforts; e.g., “feeling that I don’t give my diabetes as much attention as I probably should.”
  3. Hypoglycemia Distress: Concerns about hypoglycemic events; e.g., “feeling that I can’t ever be safe from the possibility of a serious hypoglycemic event.”
  4. Negative Social Perception Distress: Concerns about the possible negative judgments of others; e.g., “feeling like I have to hide my diabetes from other people.
  5. Eating Distress: Concerns that your eating is out of control; e.g., “feeling that thoughts about food and eating control my life.”
  6. Physician Distress: Disappointment with your current health care professionals; e.g., “feeling that I don’t get help I really need from my diabetes doctor about managing diabetes.”
  7. Friend/Family Distress: A perception that there is too much focus on diabetes amongst your loved ones; e.g., “feeling that my family and friends make a bigger deal out of diabetes than they should.”

How to score the T1-DDS

Total scale (average response across items: 1 to 28)

  • Subscale 1: Powerlessness (average of 5 items: 5, 9, 13, 21, and 25)
  • Subscale 2: Management Distress (average of 4 items: 1, 8, 12, and 28)
  • Subscale 3: Hypoglycemia Distress (average of 4 items: 3, 15, 22, and 27)
  • Subscale 4: Negative Social Perceptions (average of 4 items: 4, 10, 19, and 24)
  • Subscale 5: Eating Distress (average of 3 items: 2, 16, and 23)
  • Subscale 6: Physician Distress (average of 4 items: 7, 14, 18, and 26)
  • Subscale 7: Friend/Family Distress (average of 4 items: 6, 11, 17, and 20)

How to interpret T1-DDS total and subscale scores

  • Average score < 2.0 = indicates little or no distress
  • Average score between 2.0 and 2.9 = indicates moderate distress
  • Average score > 3.0 = indicates high distress

Any total of subscale score > 2.0 is considered clinically significant.

How to Use the T1-DDS

Use the T1-DDS to identify three levels of specificity of diabetes distress information for use in clinical care, from overall emotional distress related to diabetes to highly specific sources of diabetes distress.

Use the TOTAL SCORE as a way to begin a conversation about a patient’s overall level of Diabetes Distress and current general feelings about managing diabetes.

Review each of the 7 SUBSCALE SCORES to identify the subscale with the highest reported level of distress. Use this subscale to begin a conversation about more focused areas of concern.

Review THE ITEMS IN EACH SUBSCALE to identify the highest rated items. Use these items to begin a conversation about specific sources of diabetes distress.

How to use the T1-DDS on this website

You can download a copy of the T1-DDS in English or Spanish, along with scoring instructions.

You may also ask patients to complete the T1-DDS in English or Spanish online. The total, subscale and item scores will be computed automatically and summarized in an accompanying report, available for download or printing.


The resulting T1-DDS report can be copied and pasted into an electronic health record.

If the patient completes the T1-DDS on a phone or tablet, however, the report cannot be copied and pasted directly into another device - please email the report from a phone or tablet to a desk - or laptop to complete the copy-paste function.