Diabetes distress: What a clinician needs to know - A South Asian perspective

Diabetes distress (DD) is a phenomenon that highlights the emotional strain of having diabetes and the unrelenting demands of this illness; DD is very high and known in a poorly studied area of South Asia. This review is based on evidence published since 2023 and provides an enhancement of the 2023 South Asian Federation of Endocrine Societies (SAFES) recommendations. A 2025 systematic review and meta-analysis found pooled prevalence of type 2 diabetes distress of 85% in Pakistan, 42% in India and Bangladesh and 25% in Sri Lanka with emotional burden turning out to be the prevailing domain. The predictors of increased distress are always female gender, low socioeconomic status, prolonged period of the disease, comorbidities and poor glycemic control. Qualitative research indicates that South Asian patients are distressed due to family strain, out-of-pocket expenditure compelling them to decide whether to purchase the drug or not and fragmented health systems that isolate mental and physical health care. Cultural factors such as gendered roles in care giving, limited resources in the household budget and lack of social support increase emotional load and limit self-management. Clinicians can deal with diabetes distress by screening with validated measures and including short-term psychosocial counseling with diabetes visits, simplifying regimens to minimize hypoglycemia, addressing social support shortfalls and promoting care that is gender-sensitive and affordable. The review can guide South Asian clinicians to identify, evaluate and act on diabetes distress in resource limited, culturally diverse environments which will in turn enhance the glycemic and quality of life outcomes.