The impact of patient-centred care on adherence, psychosocial and clinical outcomes in the management of type 2 diabetes: a systematic review

Abstract

Background: Type 2 diabetes (T2D) is a chronic metabolic condition requiring sustained pharmacological and behavioural management. Suboptimal medication adherence remains a major barrier to achieving adequate glycaemic control and is associated with increased morbidity, mortality, and healthcare costs. Patient-centred care (PCC) has been widely recommended as an approach to enhance patient engagement, adherence, and clinical outcomes; however, evidence regarding its effectiveness remains inconsistent. This systematic review aimed to synthesise evidence from primary studies evaluating PCC interventions on medication adherence, glycaemic control, and psychosocial outcomes in adults with T2D. Methods: This review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420251115067). A comprehensive search of MEDLINE, Embase, EMCare, CINAHL, PsycINFO, and the Cochrane Library was conducted for studies published between 2005 and 2025. Eligible studies included primary research evaluating PCC interventions in adults with T2D and reporting adherence or clinical outcomes. Data were synthesised narratively due to heterogeneity, and vote counting based on direction of effect was applied. Risk of bias was assessed using RoB 2.0, ROBINS-I, and CASP tools, and overall certainty of evidence was evaluated using the GRADE framework. Results: Eighteen studies were included, comprising seven randomised controlled trials, eight observational studies, and three qualitative studies. PCC interventions consistently improved medication adherence and psychosocial outcomes, including patient empowerment and engagement. In contrast, effects on glycaemic control were variable, with four studies reporting improvement, seven showing no effect, and three demonstrating mixed findings. Overall, the evidence suggests a predominantly positive but inconsistent effect on HbA1c. Discussion: PCC interventions appear effective in improving behavioural and psychosocial outcomes but demonstrate inconsistent impact on glycaemic control. These findings suggest that PCC should be considered a supportive strategy to enhance engagement and adherence rather than a standalone intervention for improved clinical outcomes. Further research is required to identify optimal intervention components that can improve clinical outcomes.

Keywords

patient-centred care / type 2 diabetes / medication adherence / HbA1c / shared decision making

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