2026 EASD evidence-based clinical practice guideline for assessing and managing diabetes distress among adults with type 1 diabetes or type 2 diabetes

Diabetes distress is the emotional burden that arises from living with, and self-managing, diabetes. The aim of this clinical guideline is to optimise the assessment and management of diabetes distress among adults with type 1 diabetes or type 2 diabetes, promoting consistent, person-centred care. The guideline was developed using the EASD Standard Operating Procedure, GRADE methodology and RIGHT reporting standards. A multidisciplinary Guideline Development Panel, including lived experience experts, formulated clinical questions using the PICOT framework. Two clinical questions were addressed: (1) optimal approaches and timing for identifying and exploring diabetes distress; (2) the effectiveness of psychological, psychoeducational, educational, peer support and technology-based interventions for reducing diabetes distress. Good Practice Statements on assessment were informed by de novo realist reviews. GRADE recommendations on management were derived from a commissioned systematic review and meta-analyses of RCTs. For adults with type 1 diabetes or type 2 diabetes, eight Good Practice Statements emphasise routine discussion of emotional well-being, use of validated tools, ongoing monitoring, collaborative care planning, documentation and availability of psychological support. For adults with type 1 diabetes, conditional GRADE recommendations support psychological interventions, continuous glucose monitoring and automated insulin delivery systems for reducing diabetes distress. For adults with type 2 diabetes, conditional GRADE recommendations support psychological, psychoeducational and educational interventions for reducing diabetes distress. The strengths of this guideline include its rigorous methodology and strong stakeholder engagement. Limitations include the scarcity of high-quality trials, particularly in low- and middle-income countries, and exclusion of non-randomised evidence. Implementation will require training and system-level support for integration into routine care, in addition to dissemination through peer-reviewed publications and open access formats.