Psychosocial aspects in diabetes care: An observational study at an outpatient academic diabetes specialist centre in a metropolitan capital.

Abstract

Diabetes type 2 affects daily life, yet the psychosocial needs of patients are often overlooked. This study examines how these needs are addressed during consultations. A qualitative ethnographic study based on 47 non-participatory observations of diabetes consultations at an outpatient academic diabetes specialist centre located in a European metropolitan capital was conducted and thematically analysed using the Making Care Fit framework. Consultations focused mainly on medical aspects, while psychosocial aspects were rarely discussed. Although patients raised emotional burdens, frustrations, or shame, these concerns were rarely explored in depth. Only work-related problems were further discussed. The unique life context of patients was also rarely integrated into the care plan. Although relatives were sometimes present and clearly played a supportive role, their perspective was not actively considered. The conversation was largely provider-driven, giving patients little say in final decisions. Time constraints reinforced the focus on clinical tasks, and follow-up needs were rarely addressed. By directly observing real-time interactions, this study reveals how psychosocial needs become deprioritized in routine daily practice despite current insights emphasizing person-centered care. Acknowledging the structural constraints that shape the tension between biomedical demands and relational care, improving alignment between current diabetes care and the lived experiences of patients and their relatives will require sufficient time, a more dialogical consultation style, and systematic screening for psychosocial issues.