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

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

Aim The aim was to determine experiences, perceptions, facilitators and barriers related to weight management in T2DM/prediabetes.

Design & setting Systematic review in primary care settings.

Method A systematic search of ten 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 CASP tools and Hawker’s quality assessment tool to assess study quality, risk of bias and strength of evidence. The Joanna Briggs Institute (JBI) standards and PRISMA guidelines were adhered to, and narrative synthesis presented findings.

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

Conclusion Emergent evidence on weight management in T2DM/prediabetes indicates that stronger support and personalised approaches are essential. Tailoring programmes could improve weight management in T2DM/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/prediabetes.