T2DM and emotional well-being

T2DM has a well-documented impact on psychological and emotional well-being [12]. Research demonstrates a correlation between diabetes and negative emotions such as anxiety, depression, and distress, which negatively affect clinical outcomes, including medication nonadherence and poor glycemic control [13,14].

Approximately one-third of individuals with Type 2 diabetes mellitus (T2DM) experience distress, often associated with difficulties in disease management, concerns about potential complications, and insufficient social support [13,15]. Social relationships may be strained by the demands of the condition; however, supportive networks can mitigate distress and improve overall well-being [16,17].

T2DM and quality of life

Quality of Life (QoL) is significantly impacted by T2DM, as the condition often coexists with physical complications such as heart attack, stroke, and kidney failure, and mental complications including depression and anxiety. These factors collectively contribute to reduced well-being and increased healthcare burden [18].

Emerging evidence also highlights the role of positive psychological well-being in diabetes outcomes. A study of 3,907 individuals found that those with a stronger sense of purpose at the study’s start had a lower likelihood of developing pre-diabetes or T2DM, based on glycated hemoglobin (HbA1c) measurements. This finding is held after accounting for demographics, physical health, function, and psychiatric diagnoses [19]. Similarly, Boehm et al. [20] examined 7,800 participants over 13 years to explore the relationship between emotional vitality, optimism, and T2DM. Emotional vitality, but not optimism, was linked to a 9–15% reduction in self-reported T2DM diagnosis odds. This association remained significant even when accounting for clinical risk factors and demographics, though the effect size decreased when depressive symptoms were considered. Tsenkova et al. [21] further demonstrated that positive emotional states may reduce diabetes risk, particularly among individuals with a family history of the condition. Thus, early diagnosis and treatment of diabetes should primarily aim to improve QoL.

These findings suggest that psychological well-being is not only an outcome but also a potential protective factor in T2DM.

Self-management

Effective self-management of T2DM is essential for reducing the risk of acute and chronic complications and improving overall well-being [22]. A thorough understanding of diabetes-related complications and psychosocial issues is crucial for successful interventions [23]. Illness perception influences patients’ adherence to prescribed medications [24]. Self-management education, which includes lifestyle modifications, medication knowledge, glucose monitoring, and coping strategies, is crucial for managing T2DM [25]. However, sustaining lifestyle changes is often challenging with social support, healthcare professional guidance, and motivation being critical factors for long-term success [26].

Why this study focuses on women

This study focuses on midlife women, a group that may be particularly vulnerable to T2DM due to biological, psychological, and psychosocial factors. Women face higher risks, especially obesity and psychosocial stress, and experience unique physiological changes, such as menopause, which may influence metabolic function and heighten their susceptibility to diabetes [27].

These physiological changes, combined with socio-economic factors such as education and income, increase the likelihood of T2DM in women [28]. Women also experience more distress and stigma related to diabetes, which negatively impacts their QoL [29].

In addition, women with T2DM experience higher cardiovascular risks and increased mortality from heart disease and stroke further complicate diabetes management in women [30]. These gender differences highlight the need for more targeted and context-sensitive approaches to diabetes care. Research highlights the need for better management strategies for women, including addressing mental health and improving healthcare communication [31].

In this context the present study adopts a qualitative approach to explore how midlife women experience and interpret the impact of T2DM on their well-being across different cultures. By focusing on lived experience this study is expected to offer evidence-based recommendations for healthcare services, enhancing diabetes management for midlife women in diverse cultural settings. The results aim to guide healthcare providers and policymakers in addressing the unique challenges faced by this population in managing T2DM.

Research design and methodology

This study employed qualitative methodology through online semi-structured interviews to investigate midlife women’s perspectives on diabetes and its influence on well-being. The study was situated within an interpretivist qualitative paradigm, which assumes that reality is socially constructed and that meaning is co-produced through interaction between researcher and participant [32]. The methodological approach adopted was reflexive thematic analysis, as developed and updated by Braun and Clarke [33], which is theoretically flexible but grounded in an interpretivist epistemological position. This paradigm aligns with reflexive thematic analysis, which emphasises subjectivity, interpretation, and the researcher’s active role in knowledge production.

Participants were recruited using a pre-existing research engagement database developed through a prior national social media recruitment campaign. The database comprised approximately 600 women with diabetes who had previously expressed interest in research participation. This established sampling frame enabled focused identification of eligible participants, supporting efficient and purposeful recruitment within the qualitative paradigm. In qualitative research, rigour is determined by the richness and relevance of data and analytic depth rather than the absolute duration of fieldwork [33,34].

Interviews were recorded and transcribed using Microsoft Teams, then coded and analysed by NI using NVivo (Version 12, QSR). Each transcript was reviewed for accuracy before analysis. Thematic analysis was employed to recognise, analyse, and describe patterns within the data, allowing a deeper understanding of participants’ experiences, with reflexive thematic analysis guiding an interpretive and flexible engagement with the data [33].

The study design, data collection, and reporting were informed by the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist (S1 Appendix), and the structure of this section has been aligned with COREQ domains to enhance transparency, rigour, and methodological clarity.

Participant recruitment and eligibility

A recruitment approach was conducted from 25th March to 8th April 2024 using a multi-channel strategy, including a social media campaign on Google, Facebook, and the last author’s X (Twitter) account (IPN). Recruitment was conducted through a national social media campaign designed to enable participation from individuals residing in different regions of the UK. The term “UK-wide ” is used to describe the geographical reach of recruitment rather than to imply statistical or demographic representativeness. Consistent with qualitative research methodology, the study did not aim to produce a sample representative of the UK population but to obtain rich, in-depth accounts of lived experience. Purposeful sampling strategies prioritised experiential relevance and variation over demographic proportionality [35,36].

A total of 60 women responded to the campaign. After screening for eligibility based on the study’s inclusion criteria, 13 women were purposively selected and formally included as participants. This strategic recruitment process ensured that participants had relevant lived experience and insight to contribute meaningfully to the study aims. It also enhanced the trustworthiness and rigour of the dataset. Sample adequacy was guided by the richness and relevance of the data rather than traditional data saturation, consistent with the principles of reflexive thematic analysis [33,34,37].

Prospective participants completed a pre-screening Microsoft Form with demographic details and verification of T2DM and provided an email address for further communication. Selected participants were contacted via email and received a £20 High Street voucher. This process effectively combined recruitment and early data collection.

The study was conducted entirely online to enable inclusion of women from different regions and backgrounds without geographical or mobility constraints. Recruitment advertisements were shared across multiple platforms and diabetes-related forums to reach individuals of varying ages, ethnicities, and socioeconomic backgrounds. Study materials and interviews were conducted in English; therefore, participants were required to be fluent in English to ensure clarity and analytic consistency. Although this may have limited inclusion of non-English speakers, the use of a single interview language is methodologically common in qualitative research practice. Multilingual data collection requires extensive translation and interpretive procedures, which introduce additional methodological and conceptual challenges, particularly in preserving meaning across languages and was therefore beyond the scope of the present study [38,39].

Participants: Inclusion and exclusion criteria

The sample size consisted of 13 participants. Sample adequacy was considered in relation to the depth, specificity, and quality of the data, consistent with the concept of information power, rather than the achievement of data saturation [34].

The inclusion criteria were women aged 45–65 years, selected to represent midlife, a developmental period characterised by significant biological and psychosocial transitions, including the menopausal transition and early post‑menopause [40–42]. Midlife is widely recognised as a pivotal stage for women’s health, involving hormonal changes, shifts in metabolic function, and evolving social and health roles, all of which are associated with increased vulnerability to type 2 diabetes and may shape illness experiences and self‑management.

Participants were required to have been diagnosed with T2DM for at least two years to ensure sufficient lived experience of diagnosis, treatment initiation, and ongoing self‑management. Two participants reported a shorter duration since diagnosis (approximately one year); however, they were retained in the study due to the relevance and richness of their accounts. Their inclusion was considered to enhance the interpretive depth of the dataset by capturing experiences from earlier stages of adjustment. In qualitative research, sampling decisions are often guided by the richness, relevance, and diversity of experiences rather than strict eligibility thresholds [33,43].

Additionally, participants were required to be fluent in English, as interviews were conducted in English and translation resources were not available. Although some participants came from diverse cultural backgrounds, the interview questions were designed to be culturally neutral and sensitive, allowing participants to share their experiences freely.

Exclusion criteria included individuals with mental health issues such as depression, anxiety, or severe mental illness [44], minors, prisoners, and those unable to provide informed consent. This exclusion criterion was applied to minimise potential distress during interviews; however, it may limit the inclusion of perspectives where psychological comorbidity is present, and this is acknowledged as a limitation. No restrictions were placed on ethnicity or socioeconomic background, as the study aimed to explore experiences of women with T2DM across diverse backgrounds.

To justify the adequacy of the sample, data collection and analysis were conducted concurrently, allowing ongoing assessment of the richness and relevance of the data. In line with reflexive thematic analysis, sample size was guided by the concept of information power, whereby the specificity of the study aim, the relevance of participants’ experiences, and the depth of the interviews supported analytic sufficiency. Data collection continued until the dataset provided sufficient conceptual richness, with later interviews contributing to the refinement and elaboration of emerging themes rather than generating entirely new codes [34].

Participant characteristics are presented in Table 1.

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Table 1. Participant characteristics (N = 13).

https://doi.org/10.1371/journal.pone.0350089.t001

Interview procedure and material

Prior to participation, individuals were required to sign a written informed consent form and were provided with an information sheet outlining the purpose, procedures, potential benefits, and limitations of the research. Interviews were conducted remotely through the Microsoft Teams platform, following a briefing session to clarify the process and address any participant questions. Each interview lasted approximately 40 minutes and included open-ended questions designed to elicit detailed and reflective responses (S2 Appendix: Interview Schedule and Topic Guide). The use of videoconferencing for qualitative data collection is supported by previous research, highlighting its feasibility, acceptability, and capacity to facilitate in-depth qualitative interviews [45,46].

Development of the interview guide

The semi-structured interview guide was developed through a systematic, six-step process grounded in existing theory and literature. First, the study objectives were clarified, focusing on midlife women’s experiences of Type 2 Diabetes Mellitus (T2DM), including psychosocial aspects such as distress, stigma, self-management, and potential cultural influences. Second, an extensive literature review was undertaken to identify recurrent themes in qualitative research on diabetes-related stigma, emotional adjustment, and coping [47]. The Health Belief Model and psychosocial adjustment theories informed the conceptual structure of the guide. Third, an initial pool of questions was generated based on these themes, covering key domains such as diagnosis experiences, emotional responses, lifestyle changes, social relationships, and interactions with healthcare services. Fourth, the research team (NI and IPN) reviewed the draft guide to ensure clarity, relevance, and alignment with the study aims. Feedback led to refinements in language, logical sequencing, and the sensitivity of specific questions. Fifth, the revised guide was pilot tested with one patient and public involvement (PPI) participant living with T2DM. Feedback from this pilot interview led to further adjustments, including refining phrasing and improving transitions between topics to support a natural conversational flow. Finally, the guide was fully refined and finalised.

The completed interview guide consisted of four thematic sections:

1. Diagnosis and early experiences with T2DM
2. Lifestyle changes and daily management
3. Psychosocial and emotional aspects of living with diabetes
4. Healthcare experiences and sources of support

This structure ensured coverage of key psychosocial domains while allowing flexibility for participants to elaborate on personal experiences.

Interview Guide

A semi-structured interview guide was used to explore participants’ experiences of living with type 2 diabetes as women within their cultural communities. The guide included questions on demographic characteristics (such as age and ethnicity), diabetes history (including age at diagnosis and presence of symptoms), and perceptions of wellbeing. It also examined participants’ experiences of lifestyle changes, emotional wellbeing, healthcare interactions, social support, cultural expectations, and stigma. Additional prompts addressed coping strategies, sources of information, the role of social media, and culturally specific attitudes toward medical conditions and medication. The guide was designed to be flexible, allowing participants to elaborate on areas most relevant to their experiences. The full interview guide is provided in the S3 Appendix.

Data collection

Semi-structured interviews were conducted and recorded for accurate transcription remotely using Teams, guided by questions on emotions associated with diabetes, impact on daily life, attitudes of healthcare professionals, and coping mechanisms. The first author (NI), a female researcher with a background in psychology and MSc training in Mental Health Studies, conducted all interviews under the supervision of an experienced PhD-level qualitative researcher (IPN). Interviews were conducted between 22 April and June 2024. Brief field notes were taken after the interviews, mostly reflecting on the participant’s engagement (talkative or reserved). These notes were used to support reflexive engagement and to enhance contextual understanding during the research process. While they informed the researcher’s interpretative lens, they were not directly coded or included as part of the formal dataset, which consisted of the interview transcripts.

Interview approach

Interviews followed a logical sequence, transitioning from general to specific questions, using sensitive and appropriate language for participants. The researcher (NI) contacted participants prior to the interview to arrange scheduling, which also facilitated initial rapport-building before the interview commenced. No prior relationship existed between the researcher and participants before recruitment, beyond initial contact for scheduling. Participants were informed that the interviewer was a female researcher with a background in psychology, currently undertaking an MSc in Mental Health Studies, with a research interest in diabetes and women’s health.

Data analysis

Ιnterviews were audio-recorded, transcribed verbatim, and stored electronically. Data were analysed using reflexive thematic analysis [33], which emphasises the active role of the researcher in interpreting and constructing themes, rather than seeking coding reliability or consensus. Analysis followed the six phases described by Braun and Clarke [48], informed by their later work on reflexive thematic analysis and quality practice [33]: (1) familiarisation with the data; (2) generating initial codes; (3) developing themes; (4) reviewing themes; (5) defining and naming themes; and (6) producing the final report. Table 2 illustrates the application of these six phases, outlining the key analytic steps, outputs, and activities at each stage.

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Table 2. Application of reflexive thematic analysis (adapted from Braun & Clarke [33,48]).

https://doi.org/10.1371/journal.pone.0350089.t002

An inductive coding approach was employed, deriving codes and themes directly from participants’ accounts. The analytic process was iterative and recursive, moving back and forth between data, codes, and themes.

Both researchers (NI and IPN) first read all transcripts to gain familiarity with the dataset. NI conducted initial coding as an interpretive and reflexive process, while IPN provided ongoing supervision, critical reflection, and analytical guidance. Discussions between researchers explored alternative interpretations and enhanced analytic depth, without seeking coding consensus or inter-rater reliability, consistent with reflexive thematic analysis principles.

NVivo 12 supported organisation, coding, and management of the data, while reflexive memos documented analytic decisions, ensuring a transparent audit trail. Data were pseudonymised after analysis. Data were pseudonymised after analysis.

To enhance transparency and provide a clear audit trail, the analytic process involved several iterative steps. First, transcripts were read repeatedly to support deep familiarisation and initial notetaking. Second, initial codes were generated inductively across the dataset, capturing both semantic and latent meanings. Third, codes were grouped into preliminary themes based on shared meaning. Fourth, themes were reviewed and refined through comparison with the dataset. Fifth, themes were defined and named through reflexive discussion, focusing on conceptual clarity and relevance. Throughout this process, reflexive memos documented analytic decisions and shifts in interpretation.

To further enhance transparency, the development of codes into themes was systematically documented. Table 3 presents the final themes and subthemes derived from inductive coding, alongside the associated codes (nodes) and illustrative quotes from participants, providing a clear visual account of how the data were interpreted and organised.

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Table 3. Themes, subthemes, codes, and illustrative quotes from reflexive thematic analysis.

https://doi.org/10.1371/journal.pone.0350089.t003

Theme development was guided by conceptual relevance and interpretive depth rather than frequency, with no quantitative representation used to determine importance.

Ensuring rigour and trustworthiness

To ensure the rigour and trustworthiness of this qualitative study, we adopted multiple strategies aligned with reflexive qualitative research principles. Methodological coherence was maintained by ensuring alignment between the interpretivist paradigm, the qualitative design, and the reflexive thematic analysis approach.

Credibility was enhanced through a systematic and iterative analytic process. Both authors engaged in repeated readings of the transcripts and ongoing reflexive discussions of theme development and interpretation, ensuring close engagement with the data.

Dependability was supported by maintaining an audit trail documenting coding, theme development, and reflexive analytic decisions throughout the research process. NVivo 12 software, alongside the use of memos and annotations, facilitated systematic organisation of the data and supported transparency from initial coding to final theme development.

Confirmability was strengthened through reflexivity. The primary researcher kept reflexive notes throughout data collection and analysis, documenting assumptions, analytic choices, and potential influences on interpretation. Regular reflexive dialogue between the researchers supported critical examination of interpretations and challenged initial assumptions.

Lastly, transferability was facilitated by providing rich, detailed descriptions of the study context and participant characteristics, supported by illustrative participant quotations in the findings.

Ethical considerations

Ethical approval was obtained from King’s College London Research Ethics Office (LRU/DP-23/24–40835), on March 4, 2024. Written consent was secured from all participants before the data collection process starts. The data were securely anonymised and stored on King’s College London’s OneDrive platform. All participants provided written informed consent for the use of anonymised data in publications, and no potentially identifying details are included in the manuscript. As recruitment occurred across the UK and only broad demographic information is reported, individuals cannot be identified.

Demographics

A total of 13 women aged between 45 and 64 years participated in the study. All participants identified as female. Most participants were identified as White British, with while a smaller number represented diverse ethnic backgrounds, including Indian, European, and mixed ethnicities. The duration of Τ2DM diagnosis varied considerably, ranging from 1 to 34 years, reflecting a heterogeneous sample in terms of illness experience. No drop-out or non-participation was recorded during the study.

Theme I: Living with Type 2 diabetes

This theme reflects how participants interpreted and navigated diabetes as an ongoing condition embedded in everyday life, encompassing diagnosis, bodily experiences, and self-management practices. Rather than representing solely medical aspects, participants’ accounts highlighted how living with diabetes involved continuous negotiation and adaptation. This suggests that diabetes was not experienced as a static diagnosis but as an evolving condition requiring ongoing identity work and reinterpretation of the self in relation to health and illness. Participants’ accounts highlighted how diabetes was experienced as an ongoing condition embedded in everyday life, shaping daily routines, symptom monitoring, and management strategies.

Theme II: Psychosocial dimensions

This theme captures how living with type 2 diabetes extended beyond physical management to shape participants’ emotional well-being, social identities, and everyday interactions. Participants’ accounts highlighted that diabetes was experienced as a personally meaningful and socially embedded condition, influencing relationships, cultural practices, and daily routines. Rather than being purely in a medical condition, it was intertwined with identity, social participation, and emotional life.

Theme III: Healthcare and support

This theme explores how participants navigated healthcare systems, accessed information, and mobilised support in managing T2DM. Experiences of care were not uniform but shaped by access, communication, and individual expectations, often requiring participants to take an active role in coordinating their own support.

Theme IV: Outlook and personal development

This theme reflects how participants interpreted their future with diabetes, negotiated treatment decisions, and, in some cases, redefined their sense of self through processes of adaptation and personal growth. Rather than viewing diabetes solely as a burden, participants’ accounts revealed a more complex interplay between concern, agency, and transformation. This highlights how living with diabetes was also oriented toward the future, shaping expectations, decisions, and evolving identities.

Contradictory or unexpected findings

The study revealed important variations in how women experienced and interpreted living with T2DM. While some participants described distress, disruption, and uncertainty, others reported increased awareness, empowerment, and positive lifestyle change. These findings challenge deficit-focused narratives of chronic illness by demonstrating that, in some cases, diagnosis can act as a catalyst for reflection, learning, and proactive health behaviours [62]. Notably, the duration since diagnosis did not consistently predict adaptation or self-management success, suggesting that individual experiences are shaped by broader psychosocial and contextual factors rather than time alone.

Participants also highlighted the evolving role of digital networks. While previous research has noted the value of online communities in chronic disease management [63], our findings show that some women even prefer digital communities over immediate family for support, suggesting that virtual spaces can provide meaningful guidance, social validation, and identity affirmation, sometimes more effectively than traditional support networks. Cultural adaptation further illustrated the dynamic nature of living with T2DM. Some women described creatively modifying, rather than abandoning, cultural dietary practices, reinforcing their cultural identity while adhering to diabetes management goals. This challenges the assumption that effective self-management requires disengagement from traditional norms and suggests that culturally sensitive dietary counselling can enhance both adherence and patient satisfaction. Interestingly, negative experiences with healthcare did not uniformly lead to disengagement. Several participants responded proactively, seeking additional knowledge, experimenting with lifestyle modifications, and engaging with digital resources. This highlights patient agency and resilience, demonstrating that suboptimal care can catalyse active self-management rather than passive withdrawal. These findings extend previous research suggesting that negative healthcare experiences typically reduce engagement [64], by showing that individual motivations, social support, and access to digital resources can mediate responses to healthcare challenges.

Moreover, the emotional impact of diabetes was more heterogeneous than anticipated. While some women reported stress, isolation, or frustration, others described experiences of empowerment, increased self-awareness, and post-traumatic growth [61]. This variability indicates that emotional responses to T2DM are complex and context-dependent, and that living with the condition can catalyse unexpected positive adaptations in personal identity, lifestyle, and coping strategies.

Together, these insights underscore the unique contribution of our study: midlife women actively navigate the interplay of emotional, social, and practical dimensions of diabetes, revealing patterns of resilience and adaptation that go beyond traditional deficit-focused narratives of chronic illness.

Limitations

Despite efforts to recruit women from diverse ethnic backgrounds, the final sample remained relatively homogeneous and relatively small, which may limit the transferability of the findings. In qualitative research, transferability is achieved through the provision of rich contextual detail rather than statistical representativeness; nonetheless, the limited size and diversity of our sample may constrain the extent to which findings are applicable to broader or more heterogeneous populations.

Several potential sources of bias should be considered. Self-selection bias is likely, as participants were recruited through social media and a pre-existing research engagement database. Individuals who chose to participate may have had higher health literacy, greater digital engagement, or a stronger interest in diabetes, which may have influenced the perspectives captured. This recruitment approach, while enabling wider geographical reach and flexible participation, may have shaped the nature of the data by privileging more engaged or digitally confident individuals. Relatedly, digital recruitment may have introduced access and literacy bias, potentially underrepresenting individuals with limited access to technology or lower digital confidence. As a result, the findings may not fully reflect the experiences of less digitally connected populations, which should be considered when interpreting transferability.

Recall bias may have influenced participants’ accounts, particularly for those with longer durations since diagnosis. In addition, self-reported narratives may be shaped by social desirability, with participants presenting their experiences in ways that align with perceived expectations.

The exclusion of individuals with diagnosed mental health conditions, including depression and anxiety, represents an important limitation. While intended to reduce confounding influences, this decision may have limited exploration of psychosocial burden, which is central to the experience of living with T2DM. As such, the findings may not fully capture the range of emotional and psychological experiences associated with the condition.

Finally, although the inclusion criterion specified a minimum diagnosis duration of two years, a small number of participants had been diagnosed for only one year. This deviation may have influenced the range of experiences reported, particularly regarding adaptation and self-management strategies, and should be considered when interpreting the findings.

Strengths

This study provides rich, in-depth insights into the experiences of midlife women living with T2DM, a population that has been relatively underexplored in qualitative research on T2DM. By using semi-structured interviews, participants were able to share detailed personal accounts, capturing the complexities of daily management, emotional experiences, and identity negotiation that are often not accessible through quantitative approaches. Focusing specifically on midlife women allowed the study to illuminate experiences at a distinct life stage, addressing gaps in the literature regarding age-, gender-, and context-specific aspects of chronic illness management. The combination of rich qualitative data, interpretive thematic analysis, and attention to psychosocial and technological factors enhances the study’s contribution, framing T2DM as a complex, context-sensitive, and socially embedded condition.

The application of reflexive thematic analysis facilitated a rigorous interpretive approach, allowing the exploration of meaning-making, personal growth, and psychosocial processes beyond surface-level description. This approach highlights not only what women experience, but how they actively construct understanding and agency in managing T2DM.

Importantly, the recruitment strategy, while discussed as a limitation regarding potential selection bias, also allowed for a broader geographical reach and flexible participation, increasing the inclusivity of perspectives from women who might otherwise have been unable to participate. This approach enhanced the depth and diversity of experiential data, supporting a nuanced understanding of T2DM management in midlife.

Practical implications

The findings underscore the need for more integrated and person-centred approaches to diabetes care that address both medical and psychosocial dimensions. Interventions should move beyond a sole focus on behavioural compliance to consider emotional well-being, identity, and social context.

Approaches such as cognitive behavioural therapy (CBT) and motivational interviewing (MI) may support emotional regulation and sustained behaviour change. Healthcare professionals should adopt collaborative models of care that recognise patients as active participants, supporting shared decision-making and personalised management strategies [65].

The findings also support the integration of digital platforms into care pathways, recognising their role in providing accessible information, peer support, and opportunities for self-directed learning. Incorporating these resources into formal care structures may enhance engagement and support more holistic management [66].

Future research

Future research should explore how experiences of T2DM evolve over time through longitudinal designs, particularly in relation to identity, adaptation, and self-management practices. Cross-cultural studies are also needed to examine how social and cultural contexts shape experiences and management strategies. Further research should include individuals with common mental health comorbidities to better understand the intersection between psychological well-being and chronic disease management. In addition, the role of digital platforms in supporting long-term engagement and psychosocial outcomes warrants further investigation.