What does this research mean for the field?

Approximately 30% of adults with Type 1 diabetes exhibit 'straightlining' behaviors (giving identical responses to all items) during EHR-based diabetes distress screening, which may lead to an underestimation of actual distress levels. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to evaluate how patients respond to diabetes distress screening tools in clinical settings, focusing on the phenomenon of straightlining.

June 7, 2026

1565-P: Examining Patterns of “Straightline” Responses in EHR-Based Diabetes Distress (DD) Screening among Adults with Type 1 Diabetes (T1D)

Key Points

This study aims to evaluate how patients respond to diabetes distress screening tools in clinical settings, focusing on the phenomenon of straightlining.
Analyzed data from 563 individuals completing the T1-DDAS screener for the first time.
Screening was integrated into the EHR and sent before endocrinology appointments via MyChart.
Straightlining defined as identical Likert scale responses across the screener items.
Observed a 30% prevalence of straightlining among respondents, indicating a potential issue with screening effectiveness.
Majority (64%) of straightliners selected all 1s on the Likert scale, indicating minimal perceived distress.
Varying completion times (3 seconds to 14 minutes) suggest diverse engagement levels with the screener.

Abstract

Introduction and Objective: Guidelines recommend screening for DD. This study assessed how patients engage with DD screening instruments in a real-world clinical setting. We specifically evaluated for straightlining, i.e., when respondents give identical responses to all items in a survey. Methods: We previously built the T1-DDAS Core Scale (“screener”) into the EHR at an academic medical center, which includes 8 items, framed as statements of distress (“I am so tired of having to worry about diabetes all the time”) with Likert scale responses 1-5 (1=not a problem). The screener is sent 7 days before an endocrinology appointment via MyChart e-CheckIn. We analyzed data from 9/23/24-11/30/25, including time spent on the screener, response per item, and total score. Individual-level variables included age, sex. Straightlining was defined by the same responses on the Likert scale for each T1-DDAS item. Results: We analyzed data from 563 individuals who completed the screener for the first time. Completion time (range: 3 sec-14:49 mins; Fig A) and Core DD score (Fig B) varied. The overall prevalence of straightlining was 30% (Fig C), with most (64%) straightliners selecting all 1s (Fig D). Conclusion: The study reveals a major yet unexpected challenge of screening for DD in a real-world setting. Straightlining may contribute to underestimation of DD. Future directions include offering in-clinic and supervised screening to ensure mindful responding. Disclosure A. Fruik: None. L. Young: Research Support; Current; Boehringer Ingelheim International GmbH, Novo Nordisk, Jaeb Center for Health Research, Eli Lilly and Company, Intarcia Therapeutics, Inc., Gentibio, aqua, American Diabetes Association, American Heart Association. A. Kahkoska: Other - Dexcom provides Devices for clinical research in kind or at reduced cost, through my institution; Current; Dexcom, Inc. Funding American Diabetes Association (12-22-ACE-18)

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Cite This Study

Fruik et al. (Fri,) studied this question.

synapsesocial.com/papers/6a250be87def13d035e1bf35 https://doi.org/https://doi.org/10.2337/db26-1565-p

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