VIENNA — Healthcare professionals should discuss the emotional side of diabetes at every visit, using open-ended questions framed around the burden or challenges of living with the condition, according to new guidance from the European Association for the Study of Diabetes (EASD).

Appropriate questions to patients might be: “What's challenging you the most about your diabetes?” or “What's bothering you the most at the moment?” said lead author of the new guideline Jane Speight, PhD, foundation director of the Australian Centre for Behavioural Research in Diabetes, and chair at Diabetes Victoria and Deakin University, Melbourne, Australia. Or simply, “How can I help you?”

A draft of the “2026 EASD evidence-based clinical practice guideline for assessing and managing diabetes distress among adults with type 1 diabetes and type 2 diabetes” was presented by several of its authors here at the EASD 2025 Annual Meeting. It will be the association’s first guideline developed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology, with a writing panel that included one person each with type 1 diabetes (T1D) and type 2 diabetes (T2D). After a comment period, it is expected to be published early next year.

“Diabetes distress” refers to the emotional strain or burden arising from living with the daily demands of diabetes and can include worries, fears, guilt, frustration, or sadness around management itself, stigma, and concern about long-term complications. “Recognising the emotional burden of diabetes as a critical component of care, the aim of this guideline is to standardise the assessment and management of diabetes distress among adults with T1D and T2D,” the document states. 

Data suggest that about 1 in 3 adults with T1D and T2D experience some type of diabetes distress, while up to 80% report at least one “problem area” related to their diabetes that can lead to diabetes distress. The condition may be more common soon after diagnosis, a change in treatment, diagnosis of complications, or other life stressors. 

The expert panel reviewed about 240 studies, but the certainty of most of the evidence was graded as low, in part because there are few randomized clinical trials and, of necessity, most of the data is based on non-objective self-report, said Speight. 

But “I think there's strong evidence for the good practice statements we made, that diabetes distress needs to be assessed and normalized in the clinical consultation,” she told Medscape Medical News. “There needs to be a discussion so that there can be some shared decision making about what the person might need, and we now have evidence-based recommendations for what can support them.” 

“Good Practice Statements” Include use of Validated Tools

The following are deemed “good practice statements,” issued when a recommendation is considered “ethically imperative, clearly beneficial, and unlikely to change in light of new evidence.” For addressing diabetes distress among adults with T1D or T2D, EASD says healthcare professionals should: 

• Discuss the emotional side of diabetes at every consultation as an integral component of person-centered diabetes care.
• Ask about diabetes distress using open-ended questions, framed around the emotional burden or challenges of living with diabetes.
• Assess diabetes distress using a valid and reliable tool, such as the Diabetes Distress Scale (DDS or DDS17), Problem Areas in Diabetes scale (PAID or PAID-20), or the Diabetes Distress Assessment Scales.
• Assess and monitor diabetes distress at regular intervals, as part of the annual cycle of care.
• Acknowledge and discuss the person’s assessment, irrespective of the findings, as part of effective, person-centered care.
• Record the findings of the diabetes distress assessment in the clinical notes, and discuss them with relevant members of the healthcare team.
• When diabetes distress is identified, make a joint plan with the person living with diabetes about next steps.
• General and diabetes-specialist healthcare professionals should have the competency to offer psychological support to those experiencing diabetes distress and know how to enlist specialist support when it is needed.

Other evidence-based guidance for reducing diabetes distress in people with T1D includes use of psychological interventions in addition to usual care rather than usual care alone, and using continuous glucose monitoring (CGM), rather than capillary glucose monitoring. Educational, psychoeducational, peer support interventions, and use of automated insulin delivery systems are not advised for the purpose of reducing diabetes distress in T1D. 

For those with T2D, psychological, psychoeducational, and educational interventions are all suggested rather than usual care alone for reduction diabetes distress, but peer review and CGM are not. 

The guideline does not cover diabetes distress in children or adolescents with T1D or T2D or adults with gestational diabetes.

Aligned With ADA Position Statement

Asked to comment, Jeffrey S. Gonzalez, PhD, professor of psychology at Yeshiva University and in the departments of medicine, epidemiology, and population health at Albert Einstein College of Medicine, the Bronx, New York, told Medscape Medical News, “It's exciting to see a focus on emotional and psychological aspects of living with diabetes and its management in the EASD's first evidence-based clinical practice guideline. I think the first and most important conclusion from these guidelines is that diabetes distress is common and should be addressed as part of person-centered diabetes care.”

Gonzalez, who was a co-author on the American Diabetes Association (ADA) 2016 position statement on psychosocial care for people with diabetes, said he generally agrees with the EASD’s approach and that the new recommendations. 

They “align well” with ADA’s current Standards of Care, which also emphasize person-centered care and recommend routine assessment of, and interventions for, diabetes distress at least annually, he added. But he pointed out that the new EASD guidelines are much more specific, particularly with respect to recommending specific types of interventions.

Gonzalez, who is also director of the NY-Regional Center for Diabetes Translation Research, added that while the guidelines “appropriately” focus on diabetes distress, “other psychological and psychosocial issues are also important and likely relevant in many patients experiencing diabetes distress. For example, the ADA Standards of Care currently recommend routine assessment of diabetes distress along with assessment of depression, anxiety, disordered eating behaviors, and cognitive impairment.”

Establishing these guidelines in the real world may prove challenging, he noted. “The EASD guidelines note that implementation will take training, systems-level support, and integration into routine care to appropriately manage diabetes distress in the 'real world' and these changes would be significant for many settings, requiring additional staffing and funding. This is particularly true in the US where hospital systems often struggle to generate sufficient revenue from billing to support educational, psychoeducational, and psychological interventions.”

Nonetheless, Speight said that clinicians should embrace the guidelines because they can potentially improve the clinical encounter. 

“I believe that this is an opportunity to realize a better way of supporting people, because if you really understand how they're feeling about the condition and the challenges that they're experiencing with it, then you're going to gain their trust, and they're going to be more willing to listen to your recommendations,” she explained. 

“And that means you're probably going to be having people engaging in taking their medications and doing the things that you believe that they should probably be doing.” 

The guideline was funded by the EASD, which supported the conduct of the systematic review, the methodologists, travel and subsistence for guideline development panel members to attend two 2-day meetings, and a token honorarium to the two lived experience experts. Rapid realist reviews underpinning the Good Practice Statements were jointly funded by the UK National Institute of Health Research and Diabetes UK, as part of the D-Stress study. No industry funding was involved. Additional support was provided by Diabetes Victoria 395 and Deakin University for one of the co-chairs. Speight serves on advisory boards for Sanofi and Vertex. Gonzalez has received grants from the National Institutes of Health and the Breakthrough T1D foundation that support clinical research on diabetes distress in adults with type 1 and type 2 diabetes. 

Miriam E. Tucker is a freelance journalist based in the Washington DC area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diatribe. She is on X (formerly Twitter) @MiriamETucker and BlueSky @miriametucker.bsky.social