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Article History

Received: 14 January 2026

Accepted: 9 June 2026

First Online: 15 September 2026

Ethics

Acknowledgements: We thank the EASD Office team (P. Niemann, M. Meireles, M. Osadolor, M. Schönke, N. Buckley-Mühge, Düsseldorf) for their support throughout the guideline development process in coordinating meetings, distributing materials, facilitating communication between parties involved and record-keeping. We thank M. Meireles and M. Schönke for support with the referencing of this guideline. We also thank the Evidence Synthesis Team (EST) at Amsterdam UMC who conducted the systematic review and meta-analyses for the clinical questions on the management of diabetes distress. This team comprised S. Schipper, S. Remmelzwaal, M. Blom, N. Dagan, L. Schoonmade, M. Langendam, P. Elders and J. W. Beulens, led by F. Rutte. We thank the D-stress study team led by the Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, for access to their rapid realist reviews. This team was led by R. Harris, supported by M. Peck, S. Simms, S. Ahuja, M. Due-Christensen, C. Fabian-Therond, I. Papachristou Nadal, S. O’Connor, R. Abrams and V. Stenov. We also thank O. Kuss (Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf) and V. Lorenzoni (Scuola Superiore Sant’Anna, Pisa) for independently completing the AGREE II appraisals.

Data availability: All data extracted and analysed for the clinical practice recommendations of this guideline are available in the electronic supplementary material. These data were based on systematic and realist reviews. For access to additional data from the systematic review, which informed the management questions, contact Associate Professor Femke Rutters (email: rutters@amsterdamumc.nl); for access to additional data from the realist reviews, which informed the assessment questions, contact Professor Jackie Sturt (email: jackie.sturt@kcl.ac.uk).

Funding: This guideline was developed on behalf of, and sponsored by, the EASD. The EASD funded the work of FR and her team on the systematic reviews and meta-analyses. The EASD funded the travel expenses of the Guideline Development Panel to attend several face-to-face meetings over the course of the 2 year period. JSp is supported by core funding to The Australian Centre for Behavioural Research in Diabetes, provided by the partnership for better health between Diabetes Victoria and Deakin University. Neither organisation had any role in the development of the guideline. The D-Stress study rapid realist reviews, underpinning the Good Practice Statements, were jointly funded by the UK National Institute for Health and Care Research (NIHR) and Diabetes UK (reference NIHR205441). Neither organisation had any role in the development of the guideline and the views expressed are those of the authors and not necessarily those of Diabetes UK, the NIHR or the Department of Health and Social Care.

Role of sponsor or funder: The development of this clinical guideline was sponsored and funded by the EASD. The topic for the guideline was selected by the Guidelines Oversight Committee following a survey of the EASD membership. The Guidelines Oversight Committee appointed the GDP co-chairs and members. It ensured that the conflicts of interest of the GDP were scrutinised and that the GDP followed the Standard Operating Procedure during the development of the guideline. It oversaw the peer review process of the guideline. The EASD had no role in the formulation of the clinical questions or recommendations or the writing of this document. This guideline was approved by the Guidelines Oversight Committee and Board of the EASD. The EASD is satisfied that the guideline recommendations have been developed systematically based on the best available scientific evidence.

Authors’ relationships and activities: JSp has served on advisory boards for Sanofi and Vertex, for which her research centre (The Australian Centre for Behavioural Research in Diabetes [ACBRD]) has received honoraria. The ACBRD has also received unrestricted grants from Abbott, Lilly, Novo Nordisk and Sanofi to support the Global Summit to End Diabetes Stigma (Jaipur, India: March 2026), and sponsorship from Sanofi (unrestricted grant) to support the 30th PsychoSocial Aspects of Diabetes (PSAD) Study Group conference (Geelong, Australia: Feb 2026). NH has received advisory board fees from Abbott Diabetes Care and Dexcom and honoraria for lectures from Abbott Diabetes Care, Roche Diagnostics and Sanofi. TK received financial reimbursement from the EASD for his contribution as methodologist for this guideline and declares no conflicts of interest. FR received financial reimbursement from the EASD for execution of the systematic review and meta-analyses, which was commissioned and funded by the EASD to support the work of the Guideline Development Panel. She is a member of the editorial board of Diabetologia . JSt was a member of the Novo Nordisk Foundation Global Diabetes Forum between 2024 and 2025, during which in-person meeting attendance was supported. FZ received financial reimbursement from the EASD for his contribution as methodologist for this guideline and declares no conflicts of interest. RIGH has received honoraria for speaker engagements from Boehringer-Ingelheim, Eli Lilly, Encore, Liberum, Novo Nordisk and ROVI Pharma and consultancy fees from SPOTLIGHT-AQ. The authors declare that there are no other relationships or activities that might bias, or be perceived to bias, their work.

Contribution statement: The Guideline Development Panel (GDP) comprised JSp (Co-Chair), RIGH (Co-Chair; Co-Chair of the EASD Guidelines Oversight Committee), NH, WJ, KK, TK, ML, AM, JSt and FZ (see ESM ). JSp and RIGH conceived the topic for the guideline and led the GDP. TK and FZ advised the GDP on the methodology for developing the GRADE-based recommendations and conducted the GRADE assessments on the basis of the systematic review. JSt led the D-Stress research team, which contributed realist review evidence. All GDP members undertook GRADE training, and contributed to the development of the clinical questions and the development of the systematic review protocol of the systematic reviews, and reviewed the evidence from the systematic and realist reviews. FR led the systematic review and meta-analyses. All authors contributed to drafting of the guideline and approved the final document.