Purpose: Though many studies focus on patient perspectives of diabetes distress (DD), provider perceptions of DD require further investigation. Defined as the diabetes-specific distress related to the emotional and behavioral burden of living with type 2 diabetes (T2DM), DD is a major psychological challenge to self-management. The purpose of this qualitative study was to explore how primary care team members identify factors that contribute to DD future intervention.

Methods: Eighteen care providers from three rural nurse-managed interprofessional clinics located in Northern Virginia participated in the study. Using purposive sampling, providers were interviewed to obtain perspectives on DD in the management of T2DM. Face-to-face interviews were conducted, digitally recorded, and transcribed. Two researchers coded the transcripts into themes. Data collection and analysis occurred sequentially using a constructivist grounded approach.

Results: Provider narratives identified a lack of awareness of DD in their experiences with T2DM-related psychological and emotional challenges in a low-income, immigrant, underserved patient population. When asked about DD, most participants discussed the biomedical aspects of diabetes management, such as diet, exercise, medications, and blood glucose management. The key facilitator identified by the few participants who recognized DD was the interdisciplinary team practice model. Perceived barriers included: 1.) limited knowledge of DD by the healthcare team, 2.) under recognition of DD in reported practice, 3.) time constraints, and 4.) limited clinical experience with treating or referring patients with DD to appropriate mental health services.

Conclusions: The American Diabetes Association (ADA) Standards of Medical Care in Diabetes recommends ongoing assessment and monitoring of DD to prevent and delay its progression. Therefore, the challenge is to enhance provider understanding of DD and promote strategies and activities that help reduce DD and improve diabetes outcomes.


A. John: None.

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