What Helps Reduce Diabetes Distress?
Samantha B. J. Schipper, Thomas Karagiannis, Francesco Zaccardi, Sharon Remmelzwaal, Marieke Blom, Noa Dagan, Linda J. Schoonmade, Miranda Langendam, Martin M. Jensen, Walther Jensen, Norbert Hermanns, Karin Kanc, Michelle Law, Andreia Mocan, Theresa C. Mohr, Maartje de Wit, Petra J. M. Elders, Jackie Sturt, Joline W. Beulens, Jane Speight, Richard I. G. Holt and Femke Rutters
Interventions to reduce diabetes-related distress among adults with type 1 or type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials. Diabetologia. 2026.Sep 11. Online ahead of print.
Living with diabetes involves much more than managing glucose levels. The continuous demands of self-care, worries about complications, frustration with glucose management, social challenges and feelings of being overwhelmed can all contribute to diabetes distress: the emotional and psychological burden specifically related to living with and managing diabetes. Unlike depression or anxiety, diabetes distress is directly linked to the experience of diabetes itself. But which interventions actually help reduce diabetes distress? In this large systematic review and meta-analysis, researchers brought together evidence from 248 randomised controlled trials involving 55,497 adults with type 1 diabetes (T1D), type 2 diabetes (T2D), or mixed diabetes populations. The interventions ranged from psychological and psychoeducational approaches to diabetes education, peer support, diabetes technology, telehealth and lifestyle interventions.
Key findings:
- Psychological interventions can reduce diabetes distress: Compared with usual care, interventions such as cognitive behavioural therapy, mindfulness, motivational interviewing and supportive counselling reduced diabetes distress in adults with both T1D and T2D. The certainty of evidence was low for T1D and very low for T2D, so the magnitude of the effect should be interpreted cautiously.
- Glucose monitoring technology can also make a difference in T1D: In adults with T1D, continuous glucose monitoring (CGM) or intermittently scanned glucose monitoring significantly reduced diabetes distress compared with conventional capillary blood glucose monitoring. This finding was supported by moderate-certainty evidence.
- Automated insulin delivery showed less clear effects on diabetes distress: Although AID tended to reduce distress compared with not using AID, the pooled effect was not statistically significant. This illustrates that technological improvements in diabetes management do not necessarily translate directly into reduced emotional burden.
- Diabetes education was beneficial in T2D: Educational interventions without a specific psychological component reduced diabetes distress among adults with T2D compared with usual care. The authors suggest that improved understanding of diabetes and greater self-efficacy may help explain this effect.
- Many other interventions did not show a clear benefit: Results for psychoeducational programmes, peer support and several other approaches were inconsistent or showed little or no clear effect. Telehealth, health behaviour interventions and several heterogeneous intervention types could not be meta-analysed because studies differed too much or there were too few data.
An important message from this review is that diabetes distress deserves specific attention in routine diabetes care. Good glucose outcomes do not necessarily mean that someone is free from diabetes distress. The authors therefore support screening for diabetes distress and tailoring support to the individual. Psychological interventions may be incorporated into diabetes care or provided through referral to mental health professionals, while access to CGM may offer an additional benefit for people with T1D beyond glucose management.
At the same time, the evidence has limitations. None of the analysed trials were judged to have an overall low risk of bias: 94 had some concerns and 71 had a high risk of bias. The certainty of evidence across the meta-analyses ranged from moderate to very low, and there was considerable variation between interventions and studies. The review is particularly relevant for clinical practice because it formed the evidence base for the 2026 EASD evidence-based clinical practice guideline on assessing and managing diabetes distress in adults with T1D and T2D.
Concluding, the authors state
“To conclude, this systematic review and meta-analysis found that psychological interventions consistently reduced diabetes distress among adults with type 1 diabetes and those with type 2 diabetes, while device-related interventions reduced diabetes distress in adults with type 1 diabetes and educational interventions reduced diabetes distress in adults with type 2 diabetes.”
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