Introducing diabetes emotional wellbeing into routine consultations with adults with type 1 diabetes:A rapid realist review.

Purpose<br/>Diabetes distress affects approximately 40% of adults with type 1 diabetes and is associated with impaired self-care. Despite its prevalence, it is rarely assessed or addressed in routine care. The D-Stress study aims to develop an innovative care pathway to manage diabetes distress. A core component seeks to integrate comprehensive distress assessment with discussion into routine consultations. This rapid realist review examined how, why and in what contexts diabetes distress assessment and discussion might work to assess, manage and reduce diabetes distress among adults with type 1 diabetes.<br/><br/>Methods<br/>Following guidance for rapid realist reviews, we synthesised evidence from 36 documents identified via expert-led searches and stakeholder consultation. Data were analysed to develop programme theories explaining how the intervention might operate in clinical practice. <br/><br/>Results<br/>Eight programme theories were generated. Key mechanisms include: (1) embedding emotional health into routine care; (2) regular, comprehensive diabetes distress assessment; (3) enabling self-reflection and priority setting; and (4) supporting health professionals to tailor consultations. Evidence indicated that validated diabetes assessments with structured dialogue can normalise emotional responses and promote person-centred care. Critical contextual factors include sufficient consultation time, staff training and clear referral pathways.<br/><br/>Conclusions<br/>Comprehensive assessment with discussion may address a gap in diabetes care by integrating emotional health into routine consultations. Theories developed here suggest diabetes distress assessment and discussion may reduce risk of escalation of distress, empower adults with type 1 diabetes and strengthen therapeutic relationships. These findings will guide the realist process evaluation of the D-stress pathway highlighting contextual considerations essential for implementation.