Effectiveness of non-pharmacological interventions on metabolic control in adults with type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials.

This systematic review and meta-analysis evaluated the effectiveness of non-pharmacological interventions in improving MetS-related metabolic-control outcomes among adults with type 2 diabetes mellitus. PubMed, Scopus, ScienceDirect, and the Cochrane Library were searched from January 2005 to June 2025. Eligible randomised controlled trials compared non-pharmacological interventions with usual care, standard care, or no intervention and reported at least three prespecified metabolic syndrome components. Non-randomised studies and pharmacological, surgical, medical-device, supplement-based, or insufficiently reported interventions were excluded. Random-effects models used restricted maximum-likelihood estimation with the Knapp-Hartung adjustment, and risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Forty-two trials involving 9,586 participants were included. Interventions significantly reduced glycated haemoglobin (HbA1c; mean difference [MD] -0.43 percentage points, 95% confidence interval [CI] -0.55 to -0.32), fasting glucose (MD -0.57 mmol/L, 95% CI -0.83 to -0.32), waist circumference (MD -2.25 cm, 95% CI -3.32 to -1.19), systolic blood pressure (MD -1.66 mmHg, 95% CI -2.98 to -0.34), and diastolic blood pressure (MD -0.93 mmHg, 95% CI -1.56 to -0.30), but not triglycerides or high-density lipoprotein cholesterol. Continuous meta-regression showed no significant duration effect. Non-pharmacological interventions provide modest cardiometabolic benefits, although heterogeneity and possible small-study effects warrant caution. Registration: PROSPERO CRD420251073643.