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

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.

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).