Background Diabetes is one of the most common diseases worldwide and is associated with increased morbidity, mortality, and reduced quality of life. Many patients experience high diabetes-related distress as well as depression and anxiety symptoms, which are associated with poor diabetes self-management. As disease management is a central component in diabetes treatment, poor management enhances the occurrence of micro- and macrovascular complications. This emphasizes the relevance of reducing diabetes-related distress and providing adequate treatment options addressing the individual psychosocial burden of patients with diabetes. Since patients’ perspectives diverge significantly from those of practitioners in terms of relevant treatment aspects, the patient perspective on, for example, barriers to and facilitators of diabetes treatment is crucial for adequate and effective treatment as well as improvements to self-management and therefore, needs to be further explored. Objective This study aims to examine diabetes-related distress, the course of distress throughout diabetes management, as well as barriers and facilitating factors in dealing with diabetes from the individual perspective of patients with type 1 and type 2 diabetes. Methods The study employs a mixed methods design combining qualitative and quantitative data. Semistructured interviews (N=40) will be conducted with patients with type 1 diabetes (n=20) and patients with type 2 diabetes (n=20). The primary outcomes comprise (1) diabetes-related distress, (2) the severity of distress, (3) the course of distress throughout diabetes management, (4) barriers, and (5) facilitating factors. Questionnaires will provide data on the following secondary outcomes: diabetes-related emotional distress (the Problem Areas in Diabetes scale), symptoms of depression and anxiety (Patient Health Questionnaire, German version), personality functioning (Operationalized Psychodynamic Diagnosis-Structure Questionnaire), mentalizing capacities (Mentalization Questionnaire), epistemic trust (Epistemic Trust, Mistrust and Credulity Questionnaire) and experiences of child maltreatment (Childhood Trauma Questionnaire), and the overall health status of the patient (routine medical data). Results As of April 2022, the conceptualization phase of the study was finalized. Ethics approval was received in January 2022 from the local ethics committee of the Justus Liebig University Giessen – Faculty of Medicine (AZ 161/21). Conclusions This study will provide insights into the individual perspective of patients with type 1 and type 2 diabetes regarding their experiences with diabetes management and what they perceive to be relevant, obstructive, or beneficial. The insights gained could help further tailor diabetes treatment to the individual needs of patients with diabetes and therefore optimize diabetes self-management. Trial Registration German Clinical Trial Register DRKS00024999; https://tinyurl.com/2wb4xdh8 International Registered Report Identifier (IRRID) PRR1-10.2196/38477

BACKGROUND Diabetes is one of the most common diseases worldwide and is associated with increased morbidity, mortality and reduced quality of life. Many patients experience high diabetes-related distress as well as depression and anxiety symptoms, which are associated with poor diabetes self-management. As the disease management is a central component in diabetes treatment, poor management enhances the occurrence of micro- and macrovascular complications. This emphasizes the relevance of reducing diabetes-related distress and providing adequate treatment options addressing the individual psychosocial burden of patients with diabetes. Since the patients’ perspective diverges significantly from the practitioners’ in terms of relevant treatment aspects, the patients’ individual perspective on e.g. barriers and facilitators of diabetes treatment are crucial for adequate and effective treatment as well as improvement of self-management, and therefore need to be further explored. OBJECTIVE This study aims to examine diabetes-related distress, the course of distress throughout the diabetes management as well as barriers and facilitating factors in dealing with diabetes from the individual perspective of patients with type 1 and type 2 diabetes. METHODS The study employs a mixed-methods design combining qualitative and quantitative data. Semi-structured interviews (N=40) will be conducted with patients with type 1 diabetes (n=20) and patients with type 2 diabetes (n=20). The primary outcomes comprise (I) diabetes-related distress, (II) the severity of distress, (III) the course of distress throughout the diabetes management, (IV) barriers as well as (V) facilitating factors. Questionnaires will provide data on secondary outcomes: diabetes-related emotional distress (PAID), symptoms of depression and anxiety (PHQ-D), personality functioning (OPD-SQS), mentalizing capacities (MZQ), epistemic trust (ETMCQ) as well as experiences of child maltreatment (CTQ), and the overall health status of the patient (routine medical data). RESULTS As of April 2022, the conceptualization phase of the study conduct was finalized. The ethics approval has been received in January 2022 from the local ethics committee of the Medical Department of the Justus-Liebig University Giessen (AZ 161/21). CONCLUSIONS This study will provide insights into the individual perspective of patients with type 1 and type 2 diabetes regarding their experiences with diabetes management, and what they perceive to be particularly relevant, obstructive or beneficial. The insights gained could help tailor diabetes treatment more to the individual needs of patients with diabetes, and therefore optimize diabetes self-management. CLINICALTRIAL The study has been registered with the German Clinical Trial Register (DRKS-ID: DRKS00024999).