Psychological Care Should Be a Core Part of Diabetes Care
Per Winterdijk, Henk-Jan Aanstoot, Christine Fransman, Andreia Mocan and Giesje Nefs
Embedding psychological care in diabetes services: Why it's time to innovate and integrate. Diabet Med. 2026 Jul 30:e70411.
Living with diabetes involves much more than managing glucose levels. The continuous demands of self-management can contribute to diabetes distress, depression, anxiety, stigma and burnout. These psychological challenges can, in turn, affect self-management, glucose outcomes, quality of life and the risk of complications. Despite this, psychological care is still not consistently integrated into routine diabetes services.
In this narrative review, researchers from Diabeter and collaborating institutions brought together evidence from quantitative and qualitative research, clinical experience and lived experience. They examined what is currently known about integrating psychological care into diabetes services, which barriers prevent this from happening in practice and how diabetes care could develop in the future.
Key findings:
- Psychological care works best when it is integrated at multiple levels: The evidence supports a layered approach combining routine assessment of psychological distress, frontline psycho-education and easy access to specialist psychological therapies when needed. Psychological interventions can reduce diabetes distress and depressive symptoms, although their effects on glucose outcomes are less consistent.
- Psychological care does not always have to be delivered by a psychologist: Diabetes nurses, educators, doctors and trained peers can provide basic psychological and psycho-educational support, while psychologists can focus on complex problems, training and supervision. This approach could make psychological care more accessible despite shortages of diabetes-specialized psychologists.
- Simply measuring psychological problems is not enough: Person-reported outcomes (PROs) can help identify distress, depression, anxiety and reduced quality of life, but questionnaires should be a starting point for meaningful conversations and must be linked to appropriate follow-up care. Otherwise, assessment risks becoming a “tick-box exercise.”
- Major barriers still prevent integration into routine diabetes care: Fragmented healthcare systems, insufficient reimbursement and infrastructure, limited consultation time and shortages of trained professionals all restrict access to psychological care. Digital inequality, stigma and limited cultural adaptation of psychological tools can create additional barriers.
- A stepped or matched care model may offer a scalable solution: Routine assessment could identify people who need support, followed by relatively low-intensity interventions such as nurse-led psycho-education when appropriate and specialist psychological treatment for those with more persistent or complex needs. Digital, face-to-face and peer support could be combined depending on individual needs.
- More inclusive and real-world research is needed: Older adults, migrant populations, people with lower socioeconomic positions or limited health literacy and people with rarer forms of diabetes remain underrepresented in research. In addition to randomized trials, the authors call for participatory research, real-world data and longer-term evaluation to understand what works, for whom and in which healthcare settings.
The authors argue that psychological care should no longer be considered an optional addition to diabetes treatment. Instead, attention to psychological well-being should be embedded throughout routine diabetes care, with the level of support matched to individual needs. Achieving this will require not only changes within diabetes teams, but also appropriate training, reimbursement, infrastructure and policies that make integrated psychological care sustainable.
Importantly, questionnaires and digital tools should support rather than replace personal interaction: psychological care ultimately needs to remain grounded in dialogue and connection between people with diabetes and their healthcare team.
Concluding, the authors state
“Psychological care is not a luxury in diabetes care, but an essential element of effective, person-centred practice.”
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