Qualitative systematic review of the socioeconomic factors affecting type 2 diabetes management in Pakistan

Type 2 diabetes mellitus (T2DM) is increasing rapidly in Pakistan, especially among socioeconomically disadvantaged populations. While clinical care remains central, social determinants such as poverty, gender norms, and mistrust in healthcare critically shape disease outcomes.

To synthesize qualitative evidence on how these factors influence the experience and management of T2DM in Pakistan.

Following PRISMA guidelines, a systematic review of qualitative studies published between 2000 and 2025 was conducted on February 25, 2025 using PubMed, CINAHL, MEDLINE Plus, and PakMediNet. Eleven studies exploring socioeconomic influences on T2DM care and self-management in Pakistan were included. Thematic synthesis was used to identify key patterns. Quality was appraised using the Joanna Briggs Institute Checklist for Qualitative Research.

Three major themes were identified: (1) Economic insecurity. High cost of treatment, poor rural infrastructure, and food insecurity hinder access and adherence; (2) Sociocultural and gender norms. Restricted mobility of females, family control over health decisions, and fatalistic beliefs delay care; and (3) Knowledge gaps and mistrust. A lack of culturally appropriate education, reliance on traditional remedies, and distrust in public health systems reduce compliance. These intersecting barriers collectively impede effective diabetes management.

T2DM in Pakistan is driven by entrenched social and economic barriers. Addressing it requires culturally sensitive, equity-oriented strategies that go beyond biomedical models. Policy reforms should focus on affordability, rural outreach, and inclusive health education. Future research should engage marginalized voices through participatory methods.