Abstract
Purpose
Diabetes distress affects approximately 40% of adults with type 1 diabetes and is associated
with impaired self-care. Despite its prevalence, it is rarely assessed or addressed in routine
care. The D-Stress study aims to develop an innovative care pathway to manage diabetes
distress. A core component seeks to integrate comprehensive distress assessment with
discussion into routine consultations. This rapid realist review examined how, why and in
what contexts diabetes distress assessment and discussion might work to assess, manage
and reduce diabetes distress among adults with type 1 diabetes.
Methods
Following guidance for rapid realist reviews, we synthesised evidence from 36 documents
identified via expert-led searches and stakeholder consultation. Data were analysed to
develop programme theories explaining how the intervention might operate in clinical
practice.
Results
Eight programme theories were generated. Key mechanisms include: (1) embedding
emotional health into routine care; (2) regular, comprehensive diabetes distress
assessment; (3) enabling self-reflection and priority setting; and (4) supporting health
professionals to tailor consultations. Evidence indicated that validated diabetes assessments
with structured dialogue can normalise emotional responses and promote person-centred
care. Critical contextual factors include sufficient consultation time, staff training and clear
referral pathways.
Conclusions
Comprehensive assessment with discussion may address a gap in diabetes care by
integrating emotional health into routine consultations. Theories developed here suggest
diabetes distress assessment and discussion may reduce risk of escalation of distress,
empower adults with type 1 diabetes and strengthen therapeutic relationships. These
findings will guide the realist process evaluation of the D-stress pathway highlighting
contextual considerations essential for implementation.