Diabetes self‐management education and its association with hospital admissions and premature mortality: A scoping review and meta‐analysis

TL;DR

This study finds that diabetes self-management education may reduce mortality but not hospital admissions in type 2 diabetes patients.

Contribution

The study provides new evidence that DSME may improve survival when mortality is a primary outcome.

Findings

Meta-analysis found a non-significant 9% reduction in hospital admission risk with DSME.

Pooled analysis showed a ~45% reduction in mortality risk when mortality was a primary outcome.

Study highlights the need for standardized DSME content and outcome reporting.

Abstract

Type 2 diabetes is associated with increased all‐cause hospital admissions and premature mortality. Diabetes self‐management education (DSME) is internationally recommended but its impact on reducing hospital admissions and premature mortality is unclear. This scoping review followed the PRISMA extension for scoping reviews and explores the relationship between DSME, hospital admissions and mortality in adults with type 2 diabetes. Core search terms for type 2 diabetes were combined with terms for DSME, hospital admission, and mortality. Searches were conducted on 10 January 2024, and checked in September 2025, across three electronic databases: CINAHL, MEDLINE, and EMBASE. No restrictions were applied regarding study design, quality, location, or sex. The search yielded 294 records from databases and 66 from manual searches; 42 met inclusion criteria. Evidence regarding hospitalisation was inconsistent, with heterogenous outcome definitions and frequent reporting of admissions as a reason for attrition. Meta‐analysis showed a non‐significant 9% reduction in admission risk among DSME groups. By contrast, meta‐regression found that whether mortality was reported as a primary outcome significantly moderated the treatment effect (p = 0.0002), fully accounting for between‐study heterogeneity (τ2 = 0;
I
2
 = 0%;
R
2
 = 100%). A final pooled analysis, restricted to studies with mortality as a primary outcome, demonstrated a ~45% reduction in mortality risk (RR 0.55, 95% CI 0.47–0.63, p < 0.0001). DSME may offer a survival benefit for adults with type 2 diabetes, but current evidence does not support an association with reduced hospitalisation. Standardisation of DSME content and outcome reporting is essential to improve comparability.

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