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Peer-reviewedCC BY 4.0PLOS One

Educational and behavioural interventions for reducing fear of hypoglycaemia in adults with type 2 diabetes: A systematic review and meta-analysis of randomised controlled trials

  • Yan Tang1
  • Junjun Zhou2
  • Wan Ying Gan3
  • Kim Geok Soh4
  • Kim Lam Soh5
5 affiliations
  1. 1Department of Nursing, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
  2. 2Faculty of Nursing, Jiangsu Medical College, Yancheng, Jiangsu, China
  3. 3Department of Endocrinology, Yancheng No.1 People’s Hospital, Affiliated Hospital of Medical School, Nanjing University, Yancheng, Jiangsu, China
  4. 4Department of Nutrition, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
  5. 5Department of Sports Studies, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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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 < 0.00001). Heterogeneity was substantial (Tau² = 1.10; I² = 95%), and the 95% prediction interval crossed the line of no effect (95% PI −4.34 to 0.56), suggesting that effects may differ across future similar studies. Funnel plot asymmetry and Egger’s regression test suggested possible small-study effects. Trim-and-fill findings were estimator-dependent and suggested possible attenuation of the pooled estimate in exploratory analysis. The certainty of evidence was very low because of risk of bias, substantial heterogeneity, indirectness, and possible small-study effects. 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.

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Cite

BibTeXRIS
BibTeX
@article{tang2026educational,
  title = {{Educational and behavioural interventions for reducing fear of hypoglycaemia in adults with type 2 diabetes: A systematic review and meta-analysis of randomised controlled trials}},
  author = {Yan Tang and Junjun Zhou and Wan Ying Gan and Kim Geok Soh and Kim Lam Soh},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0358881},
  url = {https://doi.org/10.1371/journal.pone.0358881},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Educational and behavioural interventions for reducing fear of hypoglycaemia in adults with type 2 diabetes: A systematic review and meta-analysis of randomised controlled trials
AU  - Yan Tang
AU  - Junjun Zhou
AU  - Wan Ying Gan
AU  - Kim Geok Soh
AU  - Kim Lam Soh
PY  - 2026
DA  - 2026/10/05
JO  - PLOS One
DO  - 10.1371/journal.pone.0358881
UR  - https://doi.org/10.1371/journal.pone.0358881
AB  - 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 < 0.00001). Heterogeneity was substantial (Tau² = 1.10; I² = 95%), and the 95% prediction interval crossed the line of no effect (95% PI −4.34 to 0.56), suggesting that effects may differ across future similar studies. Funnel plot asymmetry and Egger’s regression test suggested possible small-study effects. Trim-and-fill findings were estimator-dependent and suggested possible attenuation of the pooled estimate in exploratory analysis. The certainty of evidence was very low because of risk of bias, substantial heterogeneity, indirectness, and possible small-study effects. 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.
SN  - 1932-6203
ER  -