Digital Health Interventions for Diabetes Distress in Type 2 Diabetes: Protocol for a Scoping Literature Review Focused on Equity and Inclusion

BACKGROUND: Managing type 2 diabetes (T2D) requires ongoing attention to diet, physical activity, medication, and blood glucose monitoring. These cumulative demands can lead to diabetes distress, a common emotional strain that affects well-being, self-management, and clinical outcomes. Digital health interventions (DHIs) offer scalable, cost-effective support for both self-management and emotional well-being. However, many DHIs pay limited attention to the needs of underserved groups, who may experience higher distress, face additional barriers to engagement, and are often underrepresented in research. Evidence describing how DHIs are designed, delivered, and experienced across diverse populations remains fragmented, particularly from an equity perspective.

OBJECTIVE: This mixed methods scoping review aims to map and characterize DHIs addressing the emotional burden of living with T2D and examine how equity and inclusion are considered in these interventions.

METHODS: Electronic searches will be conducted in several databases, including MEDLINE, CINAHL, and PsycINFO, as well as gray literature sources. Quantitative, qualitative, and mixed methods studies published since 1998 involving adults with T2D who have used DHIs targeting diabetes distress will be included. Particular attention will be given to equity, including recruitment practices, content adaptations, and provision of digital infrastructure and support. Screening and data extraction will be performed independently by multiple reviewers. Quantitative and qualitative data will be analyzed separately and integrated through descriptive mapping and thematic synthesis to identify trends, gaps, and barriers.

RESULTS: The initial search was completed in August 2025. Comprehensive database and gray literature searches, along with screening, were conducted between September and October 2025. After screening, 68 studies met the inclusion criteria. Data extraction was finalized in January 2026, with the final write-up projected for completion by summer 2026.

CONCLUSIONS: This review will identify gaps in existing DHIs and provide guidance to improve their design, inclusivity, and responsiveness to the emotional needs of adults with T2D, particularly those from ethnic minority and other underserved groups, supporting the development of user-centered, equitable solutions.