Diabetes Distress in Adults with Type 2 Diabetes and Multimorbidity: A Scoping Review.

BACKGROUND

Diabetes distress is a distinct psychological construct often conflated with depression in adults with Type 2 Diabetes Mellitus (T2DM) and multimorbidity. Current literature lacks a unified synthesis explaining how "therapeutic competition", where managing multiple conditions creates conflicting self-care demands, and cumulative regimen complexity specifically drive distress in this population.

OBJECTIVE

This scoping review systematically maps the biopsychosocial determinants of diabetes distress in adults with T2DM and multimorbidity to inform integrated, patient-centered interventions.

METHODS

A systematic search was conducted across PubMed/MEDLINE, Scopus, and EBSCOhost up to July 2025, following PRISMA-ScR guidelines. Peer-reviewed English studies examining diabetes distress in adults (≥18 years) with T2DM and multimorbidity were included. Evidence was thematically synthesized using a biopsychosocial framework.

RESULTS

Of 269 records, 17 studies met the inclusion criteria. Thematic synthesis identified a synergistic interplay across four domains. Clinically, distress was driven primarily by treatment complexity (insulin regimens, polypharmacy) rather than disease duration, and was linked to poor glycemic control. Psychologically, distress emerged as a distinct mediator between depression and self-management. Behavioral challenges included medication non-adherence and physical inactivity. Notably, sociodemographic risks revealed significant cultural divergence: while socioeconomic disadvantage was universal, marital status acted as a protective buffer in Western cohorts but a source of caregiving strain in specific non-Western contexts.

CONCLUSION

Diabetes distress in multimorbidity is a biopsychosocial phenomenon driven by therapeutic competition and context-dependent social dynamics, rather than chronicity alone. Effective management requires a paradigm shift toward integrated care that prioritizes routine screening for high-risk profiles and culturally adapted support systems.