The DDS assesses Diabetes Distress for Adults with type 2 diabetes

The DDS is a 17-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 the average responses on the 1-6 scale for all 17 items.

he scale also yields a score for each of 4 subscales based on the average response on the 1-6 scale on all of the items in that scale.T

About DDS

  • DDS Total Score: The DDS total score reflects overall diabetes distress from all sources (all 17 items).
  • Subscales: Each sub scale score reflects the average response among all items in that scale.
  • Emotional Burden (5 items): feeling overwhelmed, frightened or fearful about managing the demands of diabetes over time.
  • Regimen Distress (5 items): feeling that they are failing by not managing their diabetes well, e.g., meal plan, exercise, etc.
  • Interpersonal Distress (3 items): feeling that they are not receiving sufficient support for their diabetes among family and friends.
  • Physician Distress (4 items): worries about health care and obtaining sufficient expertise, support and direction from health care providers.

How to score the DDS

Total scale (average response across items: 1 to 17)

  • Emotional Burden: Average of 5 items (1, 4, 7, 10, 14)
  • Physician Distress: Average of 4 items (2, 5, 11, 15)
  • Regimen Distress: Average of 5 items (6, 8, 3, 12, 16)
  • Interpersonal Distress: Average of 3 items (9, 13, 17)

How to Interpret the DDS Total and Sub Scale Scores

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

A total or subscale score > 2.0 (moderate distress) is considered clinically significant.

How to Use the DDS

Use the 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 4 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 DDS on this website

You can print a copy of the DDS in English or Spanish along with scoring instructions.

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


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

If the patient completes the 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.