Technology-Enabled Collaborative Care for Diabetes and Mental Health

Change in diabetes distress score (Diabetes Distress Scale, DDS)

The DDS measures the emotional burden, regimen distress, interpersonal distress, and physician distress related to living with diabetes. Scores range from 1-6, with higher scores indicating greater distress. Outcome will be reported as mean change in total and subscale scores from baseline to 12 weeks and 6 months, with the proportion of participants achieving a clinically meaningful reduction (≥0.5 points) also reported.

Time frame: From baseline to 12 weeks post-intervention and at 6-month follow-up

Change in psychological and behavioural health symptoms (Global Appraisal of Individual Needs Short Screener, GAIN-SS)

The GAIN-SS is a validated screener for internalizing and externalizing disorders, substance use, and crime/violence problems. Scores range from 0-15 per subscale, with higher scores indicating more symptoms. Outcome will be reported as change in total and domain scores from baseline to 12 weeks and 6 months, along with the number of participants with reduced symptom severity.

Time frame: From baseline to 12 weeks post-intervention and at 6-month follow-up

Change in perceived stress score (Perceived Stress Scale, PSS)

The PSS measures the degree to which situations in one's life are appraised as stressful, with scores ranging from 0-40. Higher scores indicate greater perceived stress. Outcome will be reported as change in mean score from baseline to 12 weeks and 6 months, with distribution of participants across mild, moderate, and high stress categories also described.

Time frame: From baseline to 12 weeks post-intervention and at 6-month follow-up

Change in depressive symptoms (Patient Health Questionnaire, PHQ-9)

The PHQ-9 measures the presence and severity of depressive symptoms, with scores ranging from 0-27. Higher scores indicate more severe depression. Outcome will be reported as change in mean score from baseline to 12 weeks and 6 months, and the proportion of participants achieving clinically significant improvement (≥5-point reduction or remission, score \<5).

Time frame: From baseline to 12 weeks post-intervention and at 6-month follow-up

Change in diabetes self-management (Diabetes Self-Management Questionnaire, DSMQ)

The DSMQ assesses key self-management domains including glucose monitoring, medication adherence, diet, and physical activity. Scores range from 0-10, with higher scores indicating more effective self-management. Outcome will be reported as change in total and subscale scores from baseline to 12 weeks and 6 months.

Time frame: From baseline to 12 weeks post-intervention and at 6-month follow-up

Change in technology-enabled self-management behaviour (Diabetes Self-Management Technology Questionnaire)

This questionnaire assesses use and integration of diabetes technologies such as continuous glucose monitoring, insulin pumps, and mobile applications. Higher scores indicate more frequent or effective use of technology for self-management. Outcome will be reported as change in mean scores from baseline to 12 weeks and 6 months.

Time frame: From baseline to 12 weeks post-intervention and at 6-month follow-up