Global prevalence and correlates of diabetes distress in type 1 diabetes: A systematic review and meta-analysis

This study synthesized evidence on the prevalence of diabetes distress (DD) in type 1 diabetes (T1D) and its associations with clinical, behavioral, psychological outcomes, and diabetes technology use. We systematically searched PubMed, PsycINFO, CINAHL, EMBASE, and Scopus (from inception through April 2026) for observational studies reporting DD prevalence or correlates in T1D. Risk of bias was assessed using JBI tools. Random-effects meta-analyses were conducted, with heterogeneity assessed using I² statistics. Subgroup analyses and mixed-effects meta-regression were used to explore sources of heterogeneity. Seventy-two studies involving children, adolescents, and adults with T1D were included. The pooled prevalence of elevated DD was 38.9% (95% CI: 33.6–44.5), with higher prevalence estimates observed among females than males. DD was positively correlated with HbA1c (r = 0.24), anxiety (r = 0.42), depressive symptoms (r = 0.60) and fear of hypoglycemia (r = 0.60), and negatively correlated with self-efficacy (r = − 0.58), quality of life (r = − 0.35) and self-management behaviors (r = − 0.30). Evidence on diabetes technology use was limited and heterogenous. DD is highly prevalent in T1D and is associated with adverse clinical, behavioral, and psychological outcomes, supporting the integration of routine psychosocial screening and targeted interventions into T1D care.