Diabetes distress screening tool for Chinese-speaking patients in Singapore

13 Dec 2016. NUS clinician scientists have demonstrated the value of a screening tool to detect diabetes distress among the local patient population.

Together with their research team, Prof Joyce LEE and her Ph.D. student Melanie SIAW from the Department of Pharmacy, NUS recently demonstrated the suitability of the Chinese version of the Problem Areas in Diabetes Scale for the diabetic population in Singapore (SG-PAID-C). This screening tool includes a questionnaire designed to detect diabetes distress in local patients with uncontrolled type 2 diabetes. The research team adapted it from the Taiwanese PAID-C version and tested it among local Singaporean patients.

According to the 2015 Diabetes Atlas, the prevalence of diabetes in Singapore was 12.8%, with one in 10Chinese patients suffering from diabetes. While self-care efforts such as adherence to anti-diabetic medications, regular exercise, awell-balanced diet, and home monitoring of blood glucose are essential to prevent the complications of diabetes, these long-term efforts can be tiring and stressful. In fact, studies have shown that diabetes distress is directly associated with poorer diabetes outcomes. However, this clinical issue is often under-diagnosed, with only 28% of diabetic patients from outpatient clinics found to live with diabetes-related, severe emotional burdens.

Currently in Singapore, there is a lack of appropriate screening tools to detect diabetes distress, especially among Chinese-speaking patients. Furthermore, other screening tools cannot be directly used for Singaporean patients due to differences in cultural practices and languages. A localised version, the SG-PAID-C, is necessary to address the need to detect diabetes distress in Chinese-speaking patients in Singapore.

This study demonstrated SG-PAID-C to be a valid and reliable tool for detecting diabetes distress in Chinese-speaking Singaporean patients with uncontrolled glucose levels. The results have shown a good fit with the model.

Among the 211 Chinese type 2 diabetic patients interviewed in this study, worry about future complications was the most commonly reported diabetes distress (response = 95). This was followed by feelings related to food deprivation (response = 63), treatment plan (response = 58), and living with diabetes (response = 53) (See figure below).

The present study showed that SG-PAID-C can be an effective tool to aid in the screening of diabetes distress in Chinese-speaking Singaporean patients. However, the use of SG-PAID-C in differentiating the severity levels of diabetes distress in patients should be further evaluated via large-scale clinical trials. This will provide further validation on the clinical applicability of SG-PAID-C in assisting the management of diabetes locally.                        

43. Joyce LEE PHA 20160913 1

Figure indicates the most frequently reported diabetes distress among patients with uncontrolled type 2 diabetes (sample size: 211).



1. International Diabetes Federation. IDF general: Singapore. Available at http://www.idf.org/membership/wp/singapore.

2. Epidemiology and Disease Control Division, Ministry of Health, Singapore. National Health Survey (2010).

3. Pouwer F*; Beekman ATF; Lubach C; Snoek FJ, "Nurses' recognition and registration of depression, anxiety and diabetes-specific emotional problems in outpatients with diabetes mellitus" PATIENT EDUCATION AND COUNSELING Volume: 60 Issue: 2 Pages: 235-240 DOI: 10.1016/j.pec.2005.01.009 Published: 2006

4. Siaw MYL; Tai BBB*; Lee JYC*, “Psychometric properties of the Chinese version of the Problem Areas in Diabetes scale (SG-PAID-C) among high-risk polypharmacy patients with uncontrolled type 2 diabetes in Singapore” JOURNAL OF DIABETES INVESTIGATION doi: 10.1111/jdi.12556 [Epub ahead of print] Published: 2016.