OBJECTIVES: Management of diabetes often requires multiple daily insulin injections or insulin infusion, however the role of needle fear remains unclear. The goal of this study is to synthesize literature on needle fear prevalence, associated spectrum psychological conditions, and whether these conditions impact outcomes for patients managing diabetes (PMD).  METHODS: A literature search was conducted in PubMed and Embase to identify articles reporting either the prevalence of needle fear, injection fear, needle phobia or blood-injury-injection phobia (BII) among PMD, or reporting the clinical outcomes of these conditions. Search strings included key terms for ‘fear’, ‘phobia’, ‘anxiety’, ‘needle’, ‘insulin’, injection’, and ‘diabetes’. Articles were excluded if they focused on HIV or AIDS.  RESULTS: The literature stipulates that these conditions are underreported. Nonetheless, the literature estimates that needle fear affects 28% of adult PMD with insulin injections. Among children and adolescent PMD, the prevalence of needle or injection fear is between 9.5 and 32.7%. The estimated prevalence of needle phobia is 8.3% of children and adolescent PMD and 17.7% and 16.8% of adult men and women PMD, respectively. While no study reported a point prevalence for BII, a case-control study shows that BII does occur among PMD. Anxiety around injection or needles is associated with higher HbA1c levels and greater avoidance behavior of diabetes management, such as fewer insulin injections. Other studies have not found HbA1c to vary between those with these conditions and those without. However, one study observed higher rates of macrovascular complications (peripheral vascular disease and cardiovascular disease) in PMD with BII compared to those without.  CONCLUSIONS: While underreported, needle fear, injection fear, needle phobia and BII are prevalent among PMD. Furthermore, these fears may impact clinical outcomes among PMD. Further research should address whether these psychological conditions also impact patient satisfaction or prescribing practices.