The never‐asked: Understanding the gap in emotional support for people living with diabetes

AIMS: Diabetes distress affects about one-third of adults with diabetes and is associated with poorer health outcomes, yet routine screening by healthcare professionals remains uncommon. This study examined person-reported experiences of emotional health screening across a large Australian sample. METHODS: Adults with diabetes completed an online cross-sectional survey involving emotional health screening and assessing whether their diabetes healthcare provider had ever asked about their diabetes-related emotional health. Participant characteristics were compared by 'asked' status. A pre-specified multivariable logistic regression identified demographic and clinical predictors of never being asked. Open text responses were analysed using inductive thematic analysis. RESULTS: Of the 1092 eligible respondents (median age 57 years [IQR 44-67]; n = 676 women [62%]; diabetes duration 10 years [4-21]; n = 274 [25%] with type 1 diabetes; n = 391 [36%] using continuous glucose monitoring [CGM]), most (n = 797; 73%) reported never being asked about their diabetes-related emotional health by their diabetes healthcare provider. Approximately 42% screened positive for diabetes distress (PAID-5 ≥ 8), with similar prevalence irrespective of 'asked' status. CGM use was the strongest predictor of being asked about emotional health, with CGM non-users having nearly double the odds of never being asked (OR = 2.00, 95% CI 1.19-3.33, p = 0.007). Seven qualitative themes emerged, highlighting the emotional burden of diabetes, inconsistent care and participants' desire to be asked about emotional wellbeing. CONCLUSIONS: Most adults with diabetes in Australia are not asked about their emotional health, despite guideline recommendations. Elevated distress is common yet under-identified. Systemic changes are needed to close this gap.