Comorbid distress and depression are significant issues for people living with diabetes. Their prevalence is unknown in rural and regional Australian populations. This is a cross-sectional observational study investigating the prevalence of distress and depression in patients with diabetes mellitus in a regional NSW general practice. Patients were assessed using the World Health Organisation 5 Well-being Index (WHO-5) and the Problem Areas in Diabetes (PAID) tool during their annual diabetes review. Of 157 participants, 11.5% had likely depression, and 27.4% had low mood. Diabetes-specific distress was diagnosed in 11.7%. Both distress and low mood were present in 7.6%, of which almost a third had indications of significant depression. These values were lower than previously described in the literature, which could be attributed to various demographic, study-based and medical factors. The PAID tool was easily incorporated into practice and was reported as being clinically useful in directing consultations, leading to its subsequent addition to the annual cycle of care at the practice. Further research is needed to ascertain the rate of comorbid distress and depression in people living with diabetes in rural and regional Australian populations.