Adherence to Diabetes Self-Care Behaviors Among Patients With Diabetes Mellitus in Pakistan: A Systematic Review and Meta-Analysis Publisher Pubmed



Azizpour A ; Gheshlagh R G ; Shafiei S ; Ayaz M ; Parouhan A
Source: Diabetes Research and Clinical Practice Published:2026

Abstract

Diabetes mellitus is a major public health challenge in Pakistan. Effective management depends on adherence to self-care behaviors, yet current evidence is fragmented. This systematic review and meta-analysis synthesize evidence on adherence to diabetes self-care behaviors among Pakistani patients. PubMed, Embase, Web of Science, Scopus, Google Scholar, and PakMediNet were systematically searched up to August 2025. Observational studies assessing diabetes self-care were included. Prevalence estimates and standardized mean scores (0–100scale) were pooled. Meta-regression and publication bias analyses were conducted. Sixty-five studies (2003–2025) were included. Overall self-care pooled prevalence was 47% (95% CI: 29%–66%), with a mean standardized score of 53.6% (95% CI: 47.8%–59.4%). Medication adherence was highest (prevalence: 74%, 95% CI: 63%–83%; score: 72.7%). Physical activity showed the poorest adherence (prevalence: 37%, 95% CI: 29%–46%; score: 45.5%). Publication year was significantly associated with physical activity adherence prevalence (p = 0.02). Statistical heterogeneity was substantial across most pooled analyses, indicating considerable variability between studies. Diabetes self-care behaviors in Pakistan remain suboptimal, especially for lifestyle-related practices. The substantially higher adherence to medication than to physical activity and other self-care behaviors highlights the need for culturally appropriate interventions that strengthen lifestyle modification alongside pharmacological management. © 2026 Elsevier B.V.