Self-Efficacy, Self-Care, Glycaemic Control, and Quality of Life Among Adults With Type 2 Diabetes: A Scoping Review

Type 2 diabetes mellitus (T2DM) is no longer just a metabolic diagnosis; it is a daily test of confidence, endurance and quality of life. Traditional measures such as haemoglobin A1c (HbA1c) provide only a partial picture, while patients' beliefs about their ability to manage diabetes may be equally crucial. This scoping review examines how self-efficacy and self-care behaviours intersect with glycaemic control and health-related quality of life (HRQoL) in adults with T2DM across diverse health systems and cultures.

Following the Arksey and O'Malley framework and PRISMA-ScR guidelines, a systematic search was conducted across four databases covering January 2016 to March 2026. Studies were eligible if they included adults aged ≥ 18 years with confirmed T2DM and examined at least one of the following: diabetes self-efficacy, self-care behaviours, glycaemic control (HbA1c) or HRQoL. Thirteen studies encompassing 5784 adults with T2DM were included, spanning cross-sectional, longitudinal, quasi-experimental and randomised controlled trial designs across seven countries.

Diabetes management self-efficacy consistently outperformed knowledge in predicting self-care behaviours and HbA1c, with patients holding stronger efficacy beliefs demonstrating better metabolic control and higher HRQoL. Interventions grounded in social cognitive theory and empowerment approaches achieved clinically meaningful HbA1c reductions alongside improvements in self-care and quality of life. Advanced modelling identified a psychological cascade whereby health literacy enhanced empowerment and self-efficacy, which in turn drove self-care and improved glycaemic and HRQoL outcomes. Cluster analyses further revealed distinct high-risk subgroups, underscoring the need for stratified, individualised interventions.

In T2DM, self-efficacy consistently emerged as a central psychological factor associated with self-care behaviour, glycaemic control and quality of life. The available evidence suggests that theoretically grounded, individually tailored interventions addressing psychological and behavioural determinants, including self-efficacy, self-care, empowerment and resilience, hold promise for improving diabetes outcomes. However, further longitudinal and experimental research is needed to confirm these relationships.