Clinicians' Barriers to Screening and Diagnosing Diabetes Distress in Patients with Type 1 and 2 Diabetes Mellitus: A systematic review

Abstract

BACKGROUND People with diabetes commonly experience diabetes distress which is associated with adverse health outcomes. Although diabetes distress assessment tools are available, the condition is underdiagnosed in primary and specialised clinical settings. OBJECTIVES The systematic review aimed to identify and analyse barriers that clinicians encounter when screening for diabetes distress in patients with type 1 and 2 Diabetes Mellitus. METHODS Four databases, PubMed, ESCOB, PsycINFO and Scopus, were searched to identify relevant studies which were mapped narratively using thematic analysis. Quantitative, qualitative and mixed methods studies published in English were considered for inclusion in this systematic review without geographic limitations. RESULTS Our search identified 1579 studies, and four primary studies from three countries met the inclusion criteria. These studies reported five barriers, which included (1) lack of knowledge; (2) lack of time; (3) lack of accessibility to mental health services; (4) lack of motivation; and (5) patients' denial of their diabetes distress. The two most reported barriers were lack of knowledge and time. CONCLUSIONS The review identified critical barriers to the underdiagnosis of diabetes distress by clinicians. Further, it highlights the need for policymakers and organisations to conduct pragmatic research to understand clinicians' experiences when assessing diabetes distress in various healthcare settings to improve diabetes management.