Gender differences in self-efficacy and self-management behaviors among adults with type 2 diabetes: a systematic review and meta-analysis

A systematic meta-analysis was conducted to examine gender differences in self-efficacy and self-management among adults with Type 2 Diabetes Mellitus (T2DM). Twenty studies (2000–2025) with gender-disaggregated data were analyzed according to PRISMA 2020 guidelines. The meta-analysis used standardized mean differences (Hedges’ g; men minus women) and a multilevel random-effects model, with moderator and sensitivity analyses for behavioral domains, measurement types, regions, and study quality. The pooled effect size was small and positive (g = 0.37, 95% CI: −0.11 to 0.85), but the confidence interval included zero and heterogeneity was substantial (I² = 95.3%), indicating considerable between-study variability. Moderator analyses showed no significant differences by behavioral domain, measurement method, region, or publication year. Evidence of small-study effects and wide prediction intervals further reduced certainty in the findings. Domain-specific results (e.g., dietary self-management) were also positive but imprecise. Importantly, the certainty of evidence was rated low to very low due to imprecision, inconsistency, and potential publication bias, as assessed by the GRADE framework. Therefore, these findings should be interpreted as provisional and hypothesis-generating rather than definitive. In summary, gender differences in self-efficacy and self-management in T2DM are small, inconsistently estimated, and of low certainty, with a tendency to favor men. These results suggest that gender is not a robust determinant of diabetes self-management, and that contextual and psychosocial factors likely contribute to variability across studies. Interventions should aim to enhance self-efficacy for all individuals with T2DM using context-sensitive and gender-responsive approaches. Future research should use standardized measures, report gender-disaggregated data, and include broader geographic samples.

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