A systematic review of the perspectives of adults with type 2 diabetes mellitus or prediabetes on behavioural weight management.

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a major global health concern. Weight management in T2DM and prediabetes can improve quality of life (QoL) and glycaemic parameters. People with T2DM or prediabetes experience threats and barriers regarding weight management but current evidence is lacking in this area.

Aim: To determine experiences, perceptions, facilitators, and barriers related to weight management in people with T2DM and prediabetes.

Design & setting: Systematic review in primary care settings.

Method: A systematic search of 10 databases including MEDLINE, CINAHL Plus, and Scopus, and hand searching (2015-2025), generated 5315 qualitative and mixed-methods studies. We used Braun and Clarke's thematic analysis to synthesise data, and Critical Appraisal Skills Programme (CASP) tools and Hawker's quality assessment tool to assess study quality, risk of bias, and strength of evidence. The JBI (formerly known as the Joanna Briggs Institute) standards and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were adhered to, and findings were presented using narrative synthesis.

Results: Thematic analysis of the article texts of 43 studies identified five overarching themes regarding success or failure of weight management in T2DM and prediabetes: (i) nutrition, diet, and exercise; (ii) patient and healthcare professional (HCP) experience and knowledge; (iii) perceptions and behaviours; (iv) challenges, threats, and barriers; and (v) roles and responsibilities. While facilitators for people with T2DM and prediabetes included better support, education, motivation, diet and/or exercise adherence, and access to care-facilitated weight management, threats or barriers included time constraints, social pressure, inequalities, language barriers, and stigma. Clinicians and other HCPs are perceived to be supportive in weight management and could help overcome threats or barriers in T2DM and prediabetes.

Conclusion: Emergent evidence on weight management in type 2 diabetes mellitus (T2DM) and prediabetes indicates that stronger support and personalised approaches are essential. Tailoring programmes could improve weight management in T2DM and prediabetes. Future interventions should address inequalities, stigma, language barriers, and misinformation, and offer tailored advice on lifestyle, diet, and exercise, and improve resources for those with T2DM and prediabetes.