Abstract
BACKGROUND: Enhancing diabetes outcomes and delivering patient-centered care hinge on a thorough understanding of diabetes-related burnout. This study aimed to develop an evidence-based, consensus-guided scale to assess diabetes burnout in adults with type 2 diabetes (T2D). METHODS: A modified Delphi method was adopted. Key dimensions and potential items were identified through a literature review and qualitative patient interviews. A structured Delphi process was then used to establish expert consensus with a diverse panel comprising endocrinologists, general practitioners, and patient experts with T2D. The expert panel reviewed the draft over two rounds between April and July 2025, with consensus meetings convened after each round. The initial conceptual framework was refined through this iterative process. RESULTS: Twenty-three experts (median age 48 years [IQR 40, 54]; 87% female) participated in both rounds of the Delphi survey. After the first round, the description of one dimension and 10 items were modified. One item was split into two separate items based on expert recommendations, and two items were deleted because they did not achieve consensus. A new dimension, termed "Psychological stress" was suggested by more than two experts, along with four additional items. After the second round, all dimensions and items achieved consensus in terms of importance and feasibility. The final Diabetes Burnout Scale for T2D (DBS-T2D) comprised 26 items organized into four dimensions: psychological stress, emotional exhaustion, physical fatigue, and disengagement from diabetes management. CONCLUSIONS: The DBS-T2D was systematically developed in this study through a transparent and replicable process. Future work should focus on the scale's psychometric validation and the development of evidence-based interventions to alleviate burnout and enhance long-term health outcomes.