Effect of Diabetes Self-Management Education on HbA1c Levels and Foot Care: A Systematic Review of Current Evidence

Abstract

Background: Type 2 Diabetes Mellitus (T2DM) is a growing global health concern associated with significant morbidity, including poor glycaemic control and diabetic foot complications. Diabetes Self-Management Education (DSME) is widely promoted to enhance self-care behaviours. This review synthesised current evidence on the effect of DSME on HbA1c and foot care outcomes.

Methods: Following PRISMA guidelines, literature search was conducted in PubMed, Scopus, and Google Scholar for randomised controlled trials (RCTs) published between 2019 and 2025. Studies evaluating blended (face-to-face and computer-assisted) DSME versus usual care were included. Data were extracted and assessed for risk of bias using the Cochrane RoB2 tool. Meta-analyses were performed using forest plots, with heterogeneity assessed using I² statistics.

Results: Seven RCTs comprising 466 participants in the treatment group and 413 controls met the inclusion criteria. DSME significantly reduced HbA1c levels compared to usual care (SMD = -0.51, 95% CI: -0.95 to -0.07, p = 0.02). However, no statistically significant difference was found in foot care outcomes (SMD = 1.31, 95% CI: -1.05 to 3.66, p = 0.28).

Conclusion: Blended DSME interventions appear effective in improving glycaemic control but demonstrate limited and inconsistent effects on foot care. More high-quality, culturally diverse RCTs are required to explore DSME's role in preventing diabetic foot complications.