Objective: Diabetes mellitus is a known epidemic that is increasing throughout the United States and if current trends continue, it is estimated that as many as one in three U.S. adults could have diabetes by 2050. Considerable evidence has been found to link the presence of depression and or Diabetes Distress Syndrome with type two diabetes mellitus. Current studies demonstrate that lack of treatment of Diabetes Distress Syndrome may result in a decrease in medication adherence, participation in diabetic group meetings, and quality of life. The purpose of this study was to examine nurse practitioners (NPs') knowledge, perceptions and attitudes in utilizing behavioral therapy in TTDM management. Research Design and Methods: A total of 20 NPs completed the survey using Qualtrics. Results: suggest that there is a lack of knowledge in regards to Diabetes Distress Syndrome. Current practice for behavioral services in TTDM treatment is also deficient, however, NPs' are willing to learn more and use it as a treatment modality in their practice.