Regular insulin injection is required for lifelong treatment in patients with type 1 or 2 diabetes not well-controlled by oral medication alone 4, 5, 6. In patients with diabetes, self-care activities are performed to maintain glycated hemoglobin (HbA1c) in the target range to prevent delayed onset of devastating complications 2, 3. The total number of patients with diabetes is expected to increase from 11 million in 2000 to nearly 20 million in 2025 and may increase steadily in the future 1. Health practitioners should use the DSI to communicate with patients about their suffering. For patients with diabetes aged ≥ 10 years who self-inject insulin, the DSI was a viable and accurate method for quantifying discomfort associated with insulin injection. For measuring self-injection distress, the DSI score had good accuracy. DSI and pertinent PAID-K domains correlated strongly. Cronbach’s alpha varied from 0.69 to 0.87, and the DSI score was 0.90, demonstrating acceptable internal consistency. To assess construct and criterion validity, the correlation between the DSI scale and Korean version of the Problem Areas in Diabetes (PAID-K) scale was obtained. Internal consistency was also calculated. To verify structural validity, exploratory and confirmatory factor analyses (CFA) were conducted.

The DSI scale with 20 questions in three domains (physical, psychosocial, and process ) was developed and tested at the Samsung Medical Center in Seoul, Korea, from April to September 2021. We created a questionnaire to evaluate DSI after examining each item following a literature review. This study aimed to develop and validate the Distress of Self-Injection (DSI) scale for patients with diabetes aged ≥ 10 years. Insulin injections are stressful but necessary for people with diabetes.

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