Background: Diabetes distress is associated with poor diabetes self-management and worse clinical outcomes. Whether there is an association between patient experience of health care and degree of emotional burden (EB) of diabetes distress is not known. Objective: To investigate whether aspects of culturally competent care are associated with the EB of diabetes distress. Design: Cross-sectional survey consisting of face-to-face interviews. Subjects: A total of 502 ethnically diverse patients with diabetes receiving care in safety-net clinics in 2 cities. Measures: The main outcome measure was high EB on the Diabetes Distress Scale (mean score ≥3). The predictors were 3 domains (Doctor Communication—Positive Behaviors, Trust, and Doctor Communication-Health Promotion) of the Consumer Assessment of Healthcare Providers and Systems—Cultural Competence (Consumer Assessments of Healthcare Providers and Systems’ Cultural Competence Item Set) instrument. Results: Of 502 patients, 263 (52%) reported high EB. In adjusted logistic regressions controlling for sociodemographic and clinical factors, patient report of optimal Doctor Communication-Positive Behaviors (adjusted odds ratio, 0.46; 95% confidence interval, 0.39–0.54), and optimal Trust (adjusted odds ratio, 0.65; 95% confidence interval, 0.54–0.78) were associated with lower EB. Doctor Communication-Health Promotion Communication was not associated with EB. Discussion: Patient report of better doctor communication behavior and higher trust in physician are inversely associated with high EB among patients with diabetes. Further research should determine whether interventions improving patient physician communication and trust can lower the EB of diabetes.