Introducing diabetes emotional well-being into routine consultations for adults with type 2 diabetes.

AIMS/HYPOTHESIS: To generate initial programme theories explaining how assessment and discussion of diabetes distress could be embedded into routine type 2 diabetes care, providing a theoretical foundation for future evaluation and implementation. METHODS: A rapid realist review synthesised evidence from qualitative and quantitative studies, systematic reviews and professional commentaries. Four electronic health databases were searched between November 2024 and April 2025, and papers were selected based on their relevance and rigour. Context-mechanism-outcome configurations were developed to hypothesise mechanisms, contextual factors and outcomes associated with integration of diabetes distress assessment and discussion in routine type 2 diabetes care. RESULTS: 36 papers were included in the final synthesis. Five initial programme theories were proposed, which hypothesise that: integration could work when it (1) validates healthcare professionals' role in providing emotional support; (2) builds skills and confidence to discuss distress; (3) fosters trusting, person-centred relationships and consultations; (4) uses structured tools to facilitate dialogue; and when (5) healthcare professionals normalise routine discussion of emotional well-being. Barriers include time constraints in consultations, workload pressures, limited training and uncertainty regarding professional responsibilities. CONCLUSIONS/INTERPRETATION: The review provides a theoretical foundation for understanding how diabetes distress assessment and discussion could work in routine type 2 diabetes care. With future realist evaluation to test and refine these theories, this could address a key gap in existing literature and guide changes in clinical care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at https://doi.org/10.1007/s44357-026-00009-3.