The effectiveness of self-care interventions in working-age adults with type 2 diabetes mellitus: a systematic review and meta-analysis
Abstract
Background The prevalence of type 2 diabetes mellitus (T2DM) is rapidly increasing among working-age adults. This group faces unique challenges in sustaining effective self-care due to social and occupational demands. We conducted a systematic review and meta-analysis to evaluate the effectiveness of self-care interventions on glycemic control and self-care behaviors among working-age adults with T2DM. Methods We searched nine databases (PubMed, Embase, CINAHL, Cochrane Library, Web of Science, CBM, CNKI, CQVIP, and Wan Fang) to identify randomized controlled trials (RCTs) published from January 2020 to April 2025. Eligible studies included 18-60-year-old adults with T2DM receiving self-care interventions. Review Manager 5.4 was employed to calculate pooled mean differences (MD) with 95% confidence intervals (CI). Risk of bias was assessed using the Cochrane RoB2 tool. Results Forty-seven RCTs with 6,464 participants met the inclusion criteria. Compared to controls, self-care interventions significantly reduced HbA1c (MD −0.26, 95% CI −0.43 to −0.09), total cholesterol (MD −0.15, 95% CI −0.28 to −0.02), body mass index (MD −0.52, 95% CI −1.01 to −0.03), and increased high-density lipoproteins levels (MD 0.19, 95% CI 0.06 to 0.33). Improvements were also observed in self-care behaviors (SMD 0.74, 95% CI 0.62 to 0.86) and self-efficacy (SMD 1.14, 95% CI 0.51 to 1.76). No significant effects were found for fasting blood glucose or 2-hour plasma glucose. Substantial heterogeneity existed across studies. Conclusions Self-care interventions improved glycemic control and related outcomes in working-age adults with T2DM, although high heterogeneity and variable study quality limited interpretation and generalizability. Future trials should adopt standardized reporting systems for interventions, robust design, and longer follow-up to better inform clinical practice and public health policy. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251037017, identifier CRD420251037017.