Abstract
Aims: Diabetes distress is highly prevalent among adults with type 1 diabetes yet remains underrecognised and rarely addressed in routine diabetes care. This rapid realist review aimed to identify how, why, for whom, and in what contexts group-based interventions reduce elevated diabetes
distress in adults with type 1 diabetes, to inform the co-adaption of a new diabetes distress
intervention in the UK (‘D-Stress Reduce).
Methods: Following established rapid realist review methods, we synthesised evidence from 27
papers relating to two existing diabetes distress interventions and the psychological and social
theories underpinning them. Data extraction and analysis focused on identifying contexts,
mechanisms and outcomes, supported by stakeholders including methodological experts and
programme architects.
Results: Seven programme theories were generated and articulated through 20 “If–Then–Because”
statements. Key theories highlighted emotional regulation, peer support and person-centred
facilitation in reducing diabetes distress. Other theories included regular assessment and follow-up,
motivation for action, and empowerment in self-management. The review found that interventions
were most effective when adults with type 1 diabetes reported feeling emotionally safe, listened to
and respected, and when group facilitators shifted from directive, hierarchical communication styles
to collaborative approaches. Contextual factors such as group composition, facilitator skill, and
individual readiness for change influenced outcomes.
Conclusions: This review provides a theory-driven foundation for developing, implementing and
evaluating a new co-adapted diabetes distress intervention in the UK (‘D-Stress Reduce) and
highlights multiple components that can be addressed to improve the care pathway and groupbased
experience.