Discussion
≥0.25 increase, diabetes distress, ≥0.25 decline
SECONDARY
This secondary analysis of a randomized clinical trial established an MCID value of 0.25 for the DDS-17, 0.38 MCID for emotional distress and regimen distress subscales, and 0.39 MCID for physician distress and regimen distress subscales. Distribution-based MCIDs are a numerical score that represents the smallest value of change that would be considered meaningful anywhere along the entire range of a continuous measure. These values provide ranges for defining significant improvement (≥0.25 decline in DDS-17), no change (DDS-17 change of ≤0.25), and significant worsening (≥0.25 increase in DDS-17) in diabetes distress levels. Participants in the EPICC intervention were significantly more likely to be in the improving category and less likely to be in the worsening category. MCID improvement in the DDS-17 was associated with mean HbAThis study was the first, to our knowledge, to calculate the MCID for the DDS-17 and each of the 4 subscales of the DDS-17. A combination of both anchor- and distribution-based methods is typically perceived as the preferred method for calculating MCIDs.For the DDS-17 and its 4 subscales, we used 3 classifications to characterize change in scores from baseline to after the intervention: MCID improvement, no change, or MCID worsening. This approach adds to the binary (yes vs no) improvement concept by introducing the clinically important state of not worsening. Given the heterogeneous patterns of associations between DDS-17 MCID categories and treatment group, categorizing change in DDS-17 scores as improvement (yes vs no) or worsening (yes vs no) relative to their MCID value may indicate dual ways to frame response to a treatment: improvement or not worsening. Quantitative trends in HbA