The C-T2-DDAS is a reliable and culturally appropriate tool for assessing diabetes-related distress in Chinese adults with type 2 diabetes, demonstrating good internal consistency, strong content validity, and confirmed eight-factor structure.
The C-T2-DDAS demonstrated good internal consistency across all scales.
The C-T2-DDAS showed moderate test-retest reliability.
Content validity indices for the C-T2-DDAS were high.
Confirmatory factor analysis supported the original eight-factor structure of the C-T2-DDAS with strong model fit.
Convergent validity of the C-T2-DDAS was confirmed through strong correlation with the Chinese Diabetes Distress Scale.
The translation and cultural adaptation of the T2-DDAS into Traditional Chinese followed a two-phase methodological approach.
This research suggests that a Traditional Chinese version of a diabetes distress measurement tool — the Type 2 Diabetes Distress Assessment System (T2-DDAS) — can be reliably used with Chinese-speaking adults who have type 2 diabetes in Hong Kong. The original tool was carefully translated and culturally adapted, then tested with 292 patients at a public hospital outpatient clinic to check whether it measured what it was supposed to measure and gave consistent results. The Chinese version (C-T2-DDAS) performed well across multiple tests of reliability and validity, including strong agreement between its results and those of an existing validated Chinese diabetes distress scale. What makes this tool notable is its multidimensional structure: it assesses not only the core emotional distress that people with diabetes feel, but also seven specific sources of that distress. This means clinicians and researchers can identify not just whether someone is distressed, but why — for example, whether the distress stems from managing medications, relationships, or other factors. This level of detail could help healthcare providers tailor support and interventions more precisely to individual patients' needs. This research suggests the C-T2-DDAS is a practical and culturally suitable tool for routine screening of diabetes-related psychological distress in Chinese-speaking populations. The authors note that future work should examine how well the tool tracks changes over time and whether it is applicable to broader Chinese-speaking communities beyond Hong Kong.
Ngan H, Wong C, Choi K, Loo K, Tam H. (2026). Translation and validation of the Chinese version of Type 2 Diabetes Distress Assessment System (C-T2-DDAS).. Primary care diabetes. https://doi.org/10.1016/j.pcd.2026.01.008