Diabetes Self-Management Questionnaire (DSMQ)

The DSMQ was developed at the Research Institute of the Diabetes Academy Mergentheim. It is the first German instrument targeting diabetes self-care, designed to assess behaviors associated with metabolic control in common treatment regimens for type 1 and type 2 diabetes in adult patients.

The original questionnaire started with 37 items based on literature indicating key predictors of glycaemic control such as medication adherence, dietary adjustments, SMBG (self-monitoring of blood glucose), physical activity, and appointment adherence. After expert and patient reviews, 16 core items were selected. Overall internal consistency (Cronbach’s alpha) of the tool is good (0.84)

Each item is a behavioral statement in the first person, rated over the past 8 weeks on a four-point Likert scale from “does not apply to me” (0) to “applies to me very much” (3), with an option to mark the item as "not required" for their treatment. Higher scores indicate more effective self-care. The questionnaire provides a total score and subscale scores: Glucose Management, Dietary Control, Physical Activity, and Health-Care Use.

DSMQ Questionnaire Items

No.	Statement	Not Required	3 Applies to me very much	2 Applies to me to a considerable degree	1 Applies to me to some degree	0 Does not apply to me
1	I check my blood sugar levels with care and attention.
2	The food I choose to eat makes it easy to achieve optimal blood sugar levels.
3	I keep all doctors’ appointments recommended for my diabetes treatment.
4	I take my diabetes medication (e.g., insulin, tablets) as prescribed.
5	Occasionally I eat lots of sweets or other foods rich in carbohydrates.
6	I record my blood sugar levels regularly (or analyse the value chart with my blood glucose meter).
7	I tend to avoid diabetes-related doctors’ appointments.
8	I do regular physical activity to achieve optimal blood sugar levels.
9	I strictly follow the dietary recommendations given by my doctor or diabetes specialist.
10	I do not check my blood sugar levels frequently enough as required for good control.
11	I avoid physical activity, although it would improve my diabetes.
12	I tend to forget to take or skip my diabetes medication (e.g., insulin, tablets).
13	Sometimes I have real ‘food binges’ (not triggered by hypoglycaemia).
14	Regarding my diabetes care, I should see my medical practitioner(s) more often.
15	I tend to skip planned physical activity.
16	My diabetes self-care is poor.

🧩 Structure of the DSMQ

Following expert review and patient feedback, the questionnaire was refined to 16 final items, categorized into:

Subscale	Items	Focus Area
Glucose Management	1, 4, 6, 10, 12	Medication, glucose testing
Dietary Control	2, 5, 9, 13	Eating behavior, diet adherence
Physical Activity	8, 11, 15	Exercise routine
Health-Care Use	3, 7, 14	Appointment adherence
Sum Scale (Overall)	All 16 (incl. item 16)	Overall self-care

Each item is worded in first-person perspective and rated based on the last eight weeks to align with the glycemic index (HbA1c) time frame.

📊 Scoring Method

Responses are scored such that higher values indicate more effective self-care. Key aspects of scoring include:

Negatively worded items are reversed to maintain consistency.

Subscale and total scores are calculated by summing item scores.

Scores are then transformed to a 0–10 scale using:

$$\text{Transformed Score}=\left(\frac{\text{Raw Score}}{\text{Theoretical Max Score}}\right)\times 10$$

Theoretical max score will be 16*3 = 48

Items marked as "not required" are excluded, adjusting the denominator accordingly.

If more than half of a subscale's items are missing, the score is not computed.

Reference:

 https://hqlo.biomedcentral.com/articles/10.1186/1477-7525-11-138