Power Within: a meta-analysis of the roles of self-efficacy in type 2 diabetes self-care and glycaemic control.

Self-efficacy is a critical psychological factor in managing type 2 diabetes (T2D), yet findings across populations and measurement tools remain inconsistent. This meta-analysis investigates the associations between self-efficacy, self-care behaviours and glycaemic control (HbA1c), accounting for diabetes duration, geographic region and the type of self-efficacy scale used. A systematic search of six databases from 2007 to 2024 identified studies examining self-efficacy in relation to self-care and HbA1c in adults with T2D. Random effects models were used to pool data from 62 studies (n=19 231). Subgroup analyses explored differences by diabetes duration, global region, and measurement tool. Heterogeneity was assessed using I² and τ² statistics. Publication bias was evaluated using funnel plots, Egger's test and the trim-and-fill method. Self-efficacy was significantly associated with better self-care behaviour (r=0.44; 95% CI 0.36 to 0.51, p<0.001) and lower HbA1c (r=-0.27; 95% CI -0.37 to -0.17, p<0.001). Diabetes-specific self-efficacy measures yielded the strongest correlation with self-care (r=0.50; 95% CI 0.40 to 0.59). Stronger associations were observed in participants with shorter diabetes duration (r=0.51) and in low-income countries in East Asia (HbA1c: r=-0.34; 95% CI -0.49 to -0.17). Egger's test showed no significant publication bias (p=0.21). Sensitivity and subgroup analyses confirmed the robustness of findings despite high heterogeneity. Self-efficacy is consistently linked to improved self-care and HbA1c in T2D. Targeted interventions that enhance diabetes-specific self-efficacy, particularly early in the disease and in low-resource settings, may significantly improve diabetes outcomes globally. PROSPERO registration number CRD42024595997.