Embedding psychological care in diabetes services: Why it's time to innovate and integrate

This narrative review synthesizes current knowledge on the psychological dimensions of diabetes care, identifies gaps in evidence and practice and proposes innovative pathways for embedding psychological care into routine diabetes services.

Drawing on the authors' expertise in diabetes and behavioral science, complemented by a semi-structured literature search, the review integrates findings from quantitative studies, qualitative research, clinical experience and lived experience perspectives. Evidence was analyzed across domains of care models, research and evaluation, implementation and policy and advances in person-reported outcome measurement.

Psychological care in diabetes appears most effective when delivered through layered models: routine distress assessment, frontline psycho-education and access to specialist therapies when needed. Evidence suggests such approaches reduce distress and depressive symptoms, though glycaemic effects remain variable. Integration is constrained by structural barriers such as fragmented health systems, limited reimbursement and shortages of trained professionals. Scientific gaps include underrepresentation of older adults, migrant populations and rare diabetes subtypes, as well as a lack of longitudinal studies. Practical challenges (time pressures in clinics, digital inequality, stigma) further hinder uptake. Assessment issues also persist, with lengthy tools limiting routine use. Moving forward requires interdisciplinary and stepped/matched care models, inclusive and participatory research and policy frameworks that support reimbursement and workforce development. Advances in adaptive, streamlined and culturally sensitive measurement tools are essential to ensure psychological needs are systematically identified and addressed.

Psychological care is not a luxury in diabetes care but a core component of effective, person-centred practice, critical to achieving holistic, equitable and sustainable services.