Promoting community engagement in type 2 diabetes management: a systematic review and meta-analysis of...

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a leading global health challenge associated with high morbidity, mortality, and healthcare costs. Although effective self-management is essential, numerous patients encounter barriers owing to limited resources, cultural mismatches, and inadequate support. Community-based participatory research (CBPR) offers a collaborative framework that integrates community perspectives into program design and delivery. In this study, we systematically reviewed and meta-analyzed randomized controlled trials (RCTs) to evaluate the effectiveness of CBPR interventions on glycemic control, including subgroup analyses examining the intervention duration and facilitator type. METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Thirteen RCTs were included, all targeting adults with T2DM in community settings. Eligible interventions incorporated CBPR principles and reported glycated hemoglobin (HbA1c) as the primary outcome. Data were synthesized using a random-effects model, with Hedges’ g as the effect size. Subgroup analyses compared interventions according to duration (< 6 months vs. ≥6 months) and facilitator type (healthcare professionals vs. lay facilitators). Risk of bias was assessed using Cochrane RoB 2.0. RESULTS: Pooled analysis demonstrated a significant overall reduction in HbA1c levels (Hedges’ g = − 0.293, 95% confidence interval [CI] − 0.591 to − 0.006). Subgroup analysis revealed that interventions lasting ≥ 6 months were associated with significant improvements (effect size = − 0.30, 95% CI − 0.40 to − 0.20), whereas shorter programs showed no significant effect. Facilitator type was also influential: healthcare professional-led interventions showed greater effect sizes (–0.33, 95% CI − 0.45 to − 0.21), while lay-led programs demonstrated consistent benefits across diverse contexts (–0.19, 95% CI − 0.32 to − 0.07). Most interventions incorporated cultural tailoring and community engagement strategies, including storytelling, family-centered education, and peer support. CONCLUSIONS: This systematic review and meta-analysis provide strong evidence that CBPR is an effective and adaptable framework for T2DM management. Longer-duration programs and those involving community health workers or peer leaders are effective in sustaining glycemic improvement. These findings underscore the importance of culturally tailored community-driven strategies and highlight the practical implications of integrating CBPR into nursing practice, public health policies, and community-based diabetes care.