The dynamic interrelationships of diabetes distress uncovered by ecological momentary assessment: a systematic review

Objective: This systematic review aimed to synthesize evidence on the application of Ecological Momentary Assessment (EMA) in dynamically monitoring diabetes distress, and to examine the dynamic associations between EMA-measured psychosocial or contextual factors and diabetes distress. Methods: A systematic search of multiple English and Chinese databases was conducted up to January 13, 2026. Studies were eligible if they employed EMA to dynamically monitor diabetes distress and related psychosocial or contextual factors in individuals with diabetes. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale. Results: Seventeen studies involving a total of 1,807 participants (predominantly with type 1 diabetes) were included. The average EMA completion rate was 84.1%, with lower rates observed among adolescents compared to adults. Subjective glucose perception, the nature of social interactions, sedentary behavior, and physical symptoms showed momentary associations with diabetes distress. Distress was found to prospectively predict subsequent lapses in self-management behaviors and exacerbate negative emotional states. Conclusion: EMA is a feasible tool for assessing diabetes distress, effectively capturing its dynamic nature and real-time links with contextual factors. It provides a reference for developing timely and personalized psychological interventions in diabetes care. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251156226, identifier CRD420251156226.