Abstract
Background
Fear of hypoglycaemia (FoH) can interfere with diabetes self-management in adults with type 2 diabetes mellitus (T2DM). Educational and behavioural interventions may address hypoglycaemia-related worry and avoidance, but evidence focused on adults with T2DM remains limited. This systematic review and meta-analysis examined the effects of structured educational and behavioural interventions on FoH in this population.
Methods
Nine databases were searched from inception to 31 December 2025 for randomised controlled trials of educational and behavioural interventions addressing FoH or FoH-related outcomes in adults with T2DM. Data were pooled using random-effects models, estimating standardised mean differences (SMDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using Tau² and I², and a 95% prediction interval was estimated. Small-study effects and additional sensitivity analyses were examined. Risk of bias was assessed using Cochrane RoB 2, and certainty of evidence was assessed using GRADE. The review was registered with PROSPERO (CRD42025630957).
Results
Eleven RCTs involving 1,096 participants were included. The exploratory pooled average effect favoured educational and behavioural interventions for reducing FoH (SMD = −1.89; 95% CI −2.54 to −1.25;
p
Conclusion
Very low-certainty evidence suggests that structured educational and behavioural interventions may reduce FoH in adults with T2DM; however, the magnitude and generalisability of this effect remain uncertain. Further RCTs with standardised FoH measures, longer follow-up, and clearer reporting of intervention components and fidelity are needed.