OBJECTIVE To establish cut point(s) for the Problem Areas in Diabetes–Teens (PAID-T) scale to identify adolescents with clinically meaningful, elevated diabetes distress.

RESEARCH DESIGN AND METHODS Data were available from the Diabetes Management and Impact for Long-term Empowerment and Success (MILES) Youth–Australia Study, a national survey assessing various psychosocial indicators among self-selected National Diabetes Services Scheme registrants. Participants in the current study (n = 537) were (mean ± SD) 16 ± 2 years old, had type 1 diabetes for 6 ± 4 years, and 62% (n = 334) were girls. They completed measures of diabetes distress (PAID-T) and depressive symptoms (Patient Health Questionnaire for Adolescents) and self-reported their most recent HbA_1c and frequency of self-monitoring of blood glucose (SMBG). Relationships between the PAID-T and the psychological and clinical variables were examined to identify a clinically meaningful threshold for elevated diabetes distress. ANOVAs were used to test whether these variables differed by levels of distress.

RESULTS Two cut points distinguished none-to-mild (<70), moderate (70–90), and high (>90) diabetes distress. Moderate distress was experienced by 18% of adolescents and high distress by 36%. Mean depressive symptoms, self-reported HbA_1c, and SMBG differed significantly across the three levels of diabetes distress (all P < 0.001), with moderate-to-large effect sizes.

CONCLUSIONS Using the PAID-T, this study defined two clinically meaningful cut points to distinguish none-to-mild, moderate, and high diabetes distress in adolescents (aged 13–19). Based on these cut points, most respondents experienced at least moderate diabetes distress, which was clinically significant. Establishing thresholds for elevated diabetes distress will aid clinicians and researchers to interpret PAID-T scores, prompt discussion and intervention for those with unmet needs, and enable the effectiveness of interventions to be evaluated.

目的为糖尿病-青少年（PAID-T）量表的问题领域确定切点，以识别具有临床意义的糖尿病困扰增加的青少年。

研究设计和方法数据可从糖尿病管理和对长期赋权和成功的影响（MILES）青年-澳大利亚研究中获得，该研究是一项全国性调查，评估了一些自选国家糖尿病服务计划注册人中的各种社会心理指标。本研究的参与者（n = 537）为（平均±SD）16±2岁，患有1型糖尿病6±4年，而62％（n = 334）为女孩。他们完成了对糖尿病困扰（PAID-T）和抑郁症状（青少年患者健康问卷）的测量，并自我报告了他们最近的HbA _1c和自我监测血糖（SMBG）的频率。检查了PAID-T与心理和临床变量之间的关系，以识别出对糖尿病高危患者具有临床意义的阈值。方差分析用于检验这些变量是否因遇险程度而不同。

结果有两个切入点可区分出非轻度（<70），中度（70-90）和高（> 90）糖尿病困扰。18％的青少年经历中度困扰，36％的经历高度困扰。在三个水平的糖尿病困扰中，平均抑郁症状，自我报告的HbA _1c和SMBG均存在显着差异（所有P <0.001），且影响程度为中到大。

结论本研究使用PAID-T定义了两个具有临床意义的切入点，以区分青少年（13至19岁）的非轻度，中度和高度糖尿病困扰。基于这些切入点，大多数受访者至少经历了中度糖尿病困扰，这在临床上具有重要意义。建立糖尿病困扰加剧的阈值将有助于临床医生和研究人员解释PAID-T评分，对那些未满足需求的患者进行迅速的讨论和干预，并能够评估干预措施的有效性。