Self-care behaviours among people with type 2 diabetes mellitus in South Asia: A systematic review and meta-analysis
Open accessAbstract
Background: The burden of Type 2 Diabetes Mellitus (T2DM) in South Asian countries is increasing rapidly. Self-care behaviour plays a vital role in managing T2DM and preventing complications. Research on self-care behaviours among people with T2DM has been widely conducted in South Asian countries, but there are no systematic reviews that assess self-care behaviour among people with T2DM in South Asia. This study systematically assessed the studies reporting self-care behaviours among people with T2DM in South-Asia. Methods: Adhering to the PRISMA guidelines, we searched six bibliographic databases (Scopus, PubMed, CINAHL, Embase, Web of Science, and PsychInfo) to identify the relevant articles published between January 2000 through March 2022. Eligibility criteria included all observational and cross-sectional studies reporting on the prevalence of self-care behaviours (ie, diet, physical activity, medication adherence, blood glucose monitoring, and foot care) conducted in South Asian countries among people with T2DM. Results: The database search returned 1567 articles. After deduplication (n = 758) and review of full-text articles (n = 192), 92 studies met inclusion criteria and were included. Forward and backward reference checks were performed on included studies, which resulted in an additional 18 articles. The pooled prevalence of adherence to blood glucose monitoring was 65% (95% CI = 49-80); 64% for medication adherence (95% CI = 53-74); 53% for physical activity (95% CI = 39-66); 48% for diet (95% CI = 38-58); 42% for foot care (95% CI = 30-54). About a quarter of people with T2DM consumed alcohol (25.2%, IQR = 13.8%-38.1%) and were using tobacco products (18.6%, IQR = 10.6%-23.8%). Conclusions: Our findings suggest that the prevalence of self-care behaviours among people with T2DM in South Asia is low. This shows an urgent need to thoroughly investigate the barriers to the practising of self-care and design and implement interventions to improve diabetes self-care behaviour among people with T2DM in South Asia.
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Intervention effectiveness on specific self-care domains may vary substantially depending on responsiveness of participants and efforts required to engage in specific self-care domains.
“intervention effectiveness on specific self-care domains may vary substantially depending on the responsiveness of participants and various efforts required to engage in specific self-care domains(Paudel et al., 2022).”
From Effectiveness of acceptance and commitment therapy in people with type 2 diabetes mellitus: A systematic review and meta‐analysis. (2024) · cites this paper as Paudel et al., 2022
The Conclusion (page not available) reports that self-care behaviours differ by domain: blood glucose monitoring and medication adherence were relatively common, while physical activity, diet, and foot care were less common. The paper reviews self-care practices, not intervention effectiveness, and the cited passages do not establish that participant responsiveness or the effort required explains differences in intervention effects. (LLM, conf=0.82)
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Prevention and Management of Diabetes in South Asians
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“Poor knowledge about the disease, delayed diagnosis, poor adherence to self-care behaviours, and administration of harmful alternative medicines are the challenges for the treatment of T2DM among South-Asians [7,8].”
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“In addition, the reported mean score for dietary control (limiting sweets and carbo-hydrate-rich foods, consuming recommended diet) varied from 3.9 to 6.6 (scale range of 0-10, where 10 represents the optimal practice of self-care) [73,76,86,95].”
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Type 2 diabetes and physical activity: barriers and enablers to diabetes control in Eastern India
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“…medicines and their importance, ignorance and unwillingness, forgetfulness, poor drug supply from health facilities and poor doctor-patient relationship are significant factors for the lower adherence to medication use among the people with T2DM in South Asian countries [19,46,61,104,107].”
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“Two studies reported the mean number of days in a week participants were physically active, ranging from 4.08 to 4.23 days [20,45].”
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Diabetes Self-Care Activities: A Community-Based Survey in an Urban Slum in Hyderabad, India
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“The lower prevalence of foot care among people with T2DM in the South-Asian region might be the result of the practice of barefoot walking, use of inappropriate footwear, poor awareness of foot care and its complications, and poor counselling on foot care from service providers [148,149].”
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Burman, J., Bhattacharya, A., Chattopdhyay, A., Dey, I., Sembiah, S., & Negi, R. (2021) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_2070_20 · Cited by 9 · see citing works
Contributing Factors of Non-Adherence to Treatment among the Patients with Type II Diabetes Mellitus
Bhattarai, B., Bista, B., Shrestha, S., Budhathoki, B., & Dhamala, B. (2019) · Journal of Manmohan Memorial Institute of Health Sciences · doi:10.3126/jmmihs.v5i1.24075 · Cited by 9 · cited 3×
“…medicines and their importance, ignorance and unwillingness, forgetfulness, poor drug supply from health facilities and poor doctor-patient relationship are significant factors for the lower adherence to medication use among the people with T2DM in South Asian countries [19,46,61,104,107].”
BackgroundInfluentialKNOWLEDGE AND SELFCARE PRACTICES AMONG DIABETICS
Sheeba, S., Ak, S., & Biju, V. (2017) · doi:10.22159/ajpcr.2017.v10i12.21072 · Cited by 9
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Waisundara, V., & Shiomi, N. (2017) · InTech eBooks · doi:10.5772/intechopen.76391 · Cited by 8 · cited 1× · see citing works
“The increased prevalence of T2DM negatively affects the socioeconomic circumstances for South Asian people by increasing diabetes-related health expenditure [6].”
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“However, studies identified that time constraint, unwillingness, poor awareness level, comorbid conditions, social issues, lack of infrastructure and insufficient emphasis by physicians were the barriers to physical activity among South Asians with T2DM [59,100,120,132].”
BackgroundAyurpharmacoepidemiology Perspective
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“In addition, the reported mean score for dietary control (limiting sweets and carbo-hydrate-rich foods, consuming recommended diet) varied from 3.9 to 6.6 (scale range of 0-10, where 10 represents the optimal practice of self-care) [73,76,86,95].”
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Profile of diabetes patients' chronic illness care in India and its role in their adherence.
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“The practice of fasting, a cultural practice observed by people from various faiths, may impede compliance with medication intake [136,137].”
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Gupta, S. K., Lakshmi, P. V. M., Chakrapani, V., Rastogi, A., & Kaur, M. (2024) · PLoS ONE · doi:10.1371/journal.pone.0297132 · Cited by 30 · see citing works
Gao, R., Guo, H., Liu, Y., Pang, Y., Zhang, X., Lian, X., Yu, T., Zhu, L., & Li, F. (2023) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2023.104491 · Cited by 30 · see citing works
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Yeh, T.-T., Huang, J.-S., & Chou, Y.-C. (2025) · Journal of Foot and Ankle Research · doi:10.1002/jfa2.70051 · Cited by 5 · see citing works
“These findings align with Paudel et al.'s [46] systematic review, which found that foot care adherence (42”
Ye, Q., Xu, R., Li, L., Zhao, M., Wang, S., Peng, S.-J., Chen, S., Ahmed, F., Wu, C., & Wang, K.-F. (2024) · JMIR Aging · doi:10.2196/67312 · Cited by 5 · see citing works
“The lifestyle interventions are taken as the focal stimulus and function through providing reliable knowledge, regulated guidance, and interpersonal support theoretically [5], but face challenges of participants’ low compliance and lack of perseverance in practice [6,7].”
Yongpet, R., Seangpraw, K., & Ong-Artborirak, P. (2023) · Clinics and Practice · doi:10.3390/clinpract13060126 · Cited by 4 · see citing works
“Our results are also consistent with several studies showing that perception and intrinsic motivation are significantly positively correlated with diabetic patients’ self-care behaviors [12,33].”
ResultPaudel, G., Vandelanotte, C., Dahal, P., & Rawal, L. B. (2025) · SSM - Health Systems · doi:10.1016/j.ssmhs.2025.100083 · Cited by 4 · see citing works
Self-citationPaudel, G., Vandelanotte, C., Huda, M. M., Dahal, P. K., & Rawal, L. B. (2025) · Discover Public Health · doi:10.1186/s12982-025-00440-w · Cited by 3 · see citing works
“A systematic review conducted in South Asia, including Nepal, reported that the practice of self-care behaviours among people with T2DM is low [6].”
Self-citationGamlath, G. R. I. K., Jayalath, O. M. I., Samarakoon, S., Shrimali, M., Iriyagolla, I. M. N. D., Samarasinghe, H. G. A. S., Thilakarathna, H. K. N., & Amarasekara, T. (2023) · IECN 2023 · doi:10.3390/iecn2023-15794 · Cited by 3
“…self-care practices in diabetes management encompass behaviors like the regular monitoring of blood glucose levels, medication adherence, balanced diet, exercise, and health checkups, which significantly influence glycemic control, complication prevention, and cardiovascular risk reduction [5].”
BackgroundDiabetes distress: What a clinician needs to know – A South Asian perspective
Raza, S. A., Raza, S. I., Irfan, H., Baig, A. M., Ghauri, J. J., Shrestha, D., & HASAN, K. (2026) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2026.102116 · Cited by 2 · see citing works
Connections Among Daily Occupational Participation, Diabetes Self-Management, and Quality of Life
Segev‐Jacubovski, O., Mirza, M. P., & Rozen, D. (2025) · American Journal of Occupational Therapy · doi:10.5014/ajot.2025.050947 · Cited by 2 · see citing works
“However, the DSM activity of taking medication was relatively higher than engaging in other DSM activities, such as blood glucose checks, nutrition management, physical activity, or foot care (Coyle et al., 2013; Mogre et al., 2019; Paudel et al., 2022).”
Arroyo, M. M., Gallegos, I. R., Paublini, H., López-González, Á., López, P. T. T., Sánchez, C. M., Sastre-Alzamora, T., & Ramírez-Manent, J. I. (2025) · Medicina · doi:10.3390/medicina61040613 · Cited by 2 · see citing works
“Ethnic groups such as Hispanics, African Americans, U.S. Indigenous populations [18], South Asians [19], and populations from the Middle East [20] and Africa [21] are at higher risk.”
Era, P. (2026) · Archipel · doi:10.65739/archipel.v1i9.53 · Cited by 1
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“et al ., [4] with 5% absolute precision and 95% confidence, using the Statulator tool.”
Neupane, S., Dahal, P., Koirala, M., Thapa, R. B., Basnet, D., & Rijal, S. S. (2026) · Health Science Reports · doi:10.1002/hsr2.72230 · Cited by 2 · see citing works
Self-citationLin, S., Deed, G., Khoo, C. L., Murfet, G. O., Barclay, A., Maberly, G., Blackie, A., Peng, W., & Andrikopoulos, S. (2026) · Diabetology · doi:10.3390/diabetology7020024 · Cited by 1 · see citing works
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“Evidence shows that self-care and treatment adherence are essential for managing and controlling type 2 diabetes among the elderly [25, 26].”
The Impact of the COVID-19 Pandemic on Diabetes Self-Management in Saudi Arabia
Sales, I., Bawazeer, G. A., Shahba, A. A.-W., & Alkofide, H. (2024) · Healthcare · doi:10.3390/healthcare12050521 · Cited by 1 · see citing works
“Even in the era predating COVID-19, patients with diabetes struggled with self-management practices such as regular monitoring of blood glucose levels, medication adherence, balanced diet, exercise, and health checkups [14,15].”
BackgroundHe, J., Wang, S., Zhang, J., Li, S., Huang, X., Chongmei, H., & Liu, M. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1979499
Zhu, Q., Xia, M., Zheng, S., Gao, X., Lan, X., & Lu, S. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1941060
“…have highlighted several gaps: limited attention to the unique challenges faced by younger adults, high emphasis on glucose monitoring and medication adherence, and less focus on physical activity, diet, and foot care, and inconsistent use of theoretical frameworks to guide interventions (13 – 15).”
Pembentukan DM Care Class Boots Sebagai Upaya Peningkatan Self-Care Knowledge dan Behavior Prima
Sari, R., Soleha, U., Rohmawati, R., Faizah, I., & Hasina, S. N. (2026) · Jurnal Peduli Masyarakat · doi:10.37287/jpm.v8i3.2511
“…perawatan diri yang efektif. pasien cenderung kesulitan dalam mengontrol kadar glukosa darah, meningkatkan risiko komplikasi mikrovaskular dan makrovaskular sampai menurunkan kualitas hidup secara keseluruhan (Aloke et al., 2022; Alsaidan et al., 2023; Ferreira et al., 2024; Paudel et al., 2022).”
Sari, R. (2026) · Natural Resources for Human Health · doi:10.53365/nrfhh.210
“Patients tend to have difficulty controlling blood glucose levels, increasing the risk of microvascular and macrovascular complications and reducing overall quality of life (Aloke et al., 2022; Alsaidan et al., 2023; Ferreira et al., 2024; Paudel et al., 2022).”
Moise, M., & Ogendi, J. (2026) · International Journal For Multidisciplinary Research · doi:10.36948/ijfmr.2026.v08i04.84757
“This is comparable to 34.4% reported in Ethiopia and aligns with a systematic review of 73 studies in sub-Saharan Africa showing a 30% adequate glucose control rate with range of 10-60% [17] [18].”
InfluentialLiving alone with diabetes: a phenomenological study
Susianty, S., Mailani, F., Sari, I., Lagadec, D. L., & Johnston‐Devin, C. (2026) · British Journal of Community Nursing · doi:10.12968/bjcn.2025.0230
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Predicting complications for diabetes in South Asians: Beyond convention
Lin, B., Lim, L.-L., Mohan, V., & Shaw, J. E. (2026) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2026.102119
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“[17] All these studies have found poor self‑care behavior amongst diabetic patients about diet, physical activity, foot care and blood glucose monitoring.”
The role of self-management in the rehabilitation of type 2 diabetes patients
Kryukova, I. V. (2026) · Journal of Medical Rehabilitation · doi:10.17749/2949-5873/rehabil.2025.54
Phuong, T. V. P., Lan, T. P., & To, K. (2026) · International Journal of Noncommunicable Diseases · doi:10.4103/jncd.jncd_130_25
Determinants of self-monitoring adherence in type 2 diabetes: bridging the gap in patient care
Hyassat, D., Alonezat, K., Abdalrahim, M., Batieha, A., Khader, Y., Alnsour, S., Al-Qalalweh, S. B., & Ajlouni, K. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1784888
“Higher adherence rates have been documented in some regions; for example, a systematic review and meta-analysis by Paudel et al. (39) reported relatively high SMBG adherence in South Asian countries, including 68% in India and 66% in Pakistan.”
Tahir, A., Khan, K., Hasan, M. K., Jamil, H., Jamil, T., & Hakeem, S. (2026) · Journal of Basic & Clinical Medical Sciences · doi:10.58398/0002.000034
Behavior change techniques to improve treatment adherence in type 2 diabetes: A systematic review
Villalpando-Gutiérrez, A. R., Velázquez-Jurado, H., Burguete, C. P., Colín-Mendiola, K. P., Grostieta-Dominguez, J. E., García-Ulloa, A. C., & Pérez-Peralta, L. (2026) · Endocrinología Diabetes y Nutrición (English ed ) · doi:10.1016/j.endinu.2026.501774
Sugiharto, S., & Hsu, Y.-Y. (2026) · Indonesian Contemporary Nursing Journal (ICON Journal) · doi:10.20956/icon.v10i2.46029
“Paudel et al. (2022) reported that the adherence rates for self-care in South Asia were approximately 64% for medication, 53% for physical activity, 48% for nutrition, and 42% for foot care.”
Knowledge And Foot Care Behavior in Patients With Diabetes Melitus: Study of Corelation
Imamah, I., Kusuma, G. H., & Margatot, D. I. (2026) · Infokes Jurnal Ilmiah Rekam Medis dan Informatika Kesehatan · doi:10.47701/ydbqha03
Basha, A., Boka, A., & Aga, F. (2026) · SAGE Open Nursing · doi:10.1177/23779608261417806
“…much lower than reports from Sri Lanka, Bangladesh, Malawi, and several sub-Saharan African countries (Banda et al., 2019; Palermi et al., 2022; Paudel et al., 2022; Saumika et al., 2019), as well as fi ndings from Dire Dawa, Dilla Referral Hospital, and Nekemte in Ethiopia (Addisu et al.,…”
Dey, A., & Ray, K. (2025) · International Journal of Health Sciences and Research · doi:10.52403/ijhsr.20251127
Self-management program impact on type 2 diabetes blood sugar control
Kawthaisong, C., Wongsricha, P., & Machara, C. (2025) · International Journal of Public Health Science (IJPHS) · doi:10.11591/ijphs.v14i4.26501
“The intervention focused on enhancing patients' self-management capabilities through skill-building exercises, including training on blood glucose measurement (Dextrostix) and developing individualized goals for nutrition and exercise [24], [25].”
Pardoel, Z., Folkertsma, I., Ramani-Chander, A., Thrift, A. G., Joshi, R., Bandurek, I., van Olmen, J., Shrestha, A., Rawal, L. B., Wouters, E., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-101292 · Cited by 1 · see citing works
Self-citationLakshmi Pathy, Y., & F, S. (2025) · Journal of MedVerse Research & Practice · doi:10.65188/nurexus.1049
INFLUENCE OF SELF-STIGMA ON SELF-CARE BEHAVIOUR AMONG SUBJECTS WITH DIABETES MELLITUS
Suvathi, R., Chinnaiah, R., Vinesh, E., Arunachalam, M., Divya, S., & Rajesh, E. (2025) · BULLETIN OF STOMATOLOGY AND MAXILLOFACIAL SURGERY · doi:10.58240/1829006x-2025.21.7-277
Tariq, M., Ansari, I., Tariq, A., Younas, I., Khalid, M., Khaliq, R., & Fatima, S. (2025) · International Journal of Research in Medical Sciences · doi:10.18203/2320-6012.ijrms20253138
Rohani, H., Osanloo, J., Moshki, M., Mokhtari, A. M., & Jafari, A. (2025) · Scientific Reports · doi:10.1038/s41598-025-17974-3
Guimarães, B. M., Coqueiro, J. M., Tolentino, D., Gama, A. S., Magalhães, B., Lucas, L. P., Guarneire, G. J., de Souza, M. C., Alves, C. C. D. S., & Carli, A. D. P. (2025) · Discover Public Health · doi:10.1186/s12982-025-00617-3
Bofu, H., Msollo, S., & Mwanri, A. (2024) · Tanzania Journal of Health Research · doi:10.4314/thrb.v25i2.8
“Contrasting results have been shown by other studies with a very high rate of adhering to regular SMBG compared to other practices, for example, the study done by Al-Ozairi et al. (2023) in Arab population and a systematic review conducted by Paudel et al. (2022).”
ResultKurnia, A., Said, F., & Paduragan, S. L. (2024) · International Journal of Health Sciences · doi:10.59585/ijhs.v2i1.336
“Healthy behavior can lower complications and death in type 2 diabetes patients; nevertheless, Asian individuals are less likely to practice self-care (Paudel et al., 2022).”
BackgroundSelf-Care Behaviors and Treatment Adherence Among Patients With Type 2 Diabetes Mellitus and Stroke
Vũ, T. M., Nguyễn, H. T., Trần, T. V., Nguyễn, N. T. T., Phan, T. N., Hoang, H., & Ta, H. T. T. (2026) · Tạp chí thần kinh học Việt Nam · doi:10.62511/vjn.51.2026.121
- Authors
- Paudel, G., Vandelanotte, C., Dahal, P. K., Biswas, T., Yadav, U. N., Sugishita, T., & Rawal, L.
- Affiliations
- Central Queensland University (AU)
- The University of Queensland (AU)
- Australian National University (AU)
- Tokyo Women's Medical University (JP)
- Western Sydney University (AU)
- Corresponding author
- Paudel, Grish
- ORCID
- Venue
- Journal of Global Health
- Published
- 2022-08-03
- Volume
- 12
- Pages
- 04056-04056
- ISSN
- 2047-2978 (ISSN-L)
- 2047-2986
- PMC
- PMC9346342
- OpenAlex
- W4289516661
- Cited by
- 54
- References
- 148
- Citations by year
- 2026: 19 · 2025: 21 · 2024: 7 · 2023: 6 · 2022: 1
- FWCI
- 1.25
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Global Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- Australian Government
- University of Sydney
- Faculty of Medicine and Health, University of Sydney
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- type 2 diabetes, diabetes self-care, South Asia, blood glucose monitoring, medication adherence, physical activity, diet, foot care, alcohol consumption, tobacco use, barriers to self-care
- MeSH terms
- Asia, Blood Glucose, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Humans, Self Care, Blood Glucose Self-Monitoring
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