Abstract
BACKGROUND: Therapeutic patient education (TPE) is a structured, person-centered educational process designed to empower individuals living with non-communicable diseases, such as diabetes mellitus. Educational interventions addressing diabetes in the Eastern Mediterranean Region (EMR) are isolated , and their effectiveness is not well reported. Therefore, this systematic review evaluates the impact of TPE interventions on diabetes self-management outcomes in the EMR. METHODS: We searched six databases (MEDLINE OVID, PubMed, Web of Science, Scopus, CINAHL, and ScienceDirect) for relevant articles. Articles were included if they reflected on TPE initiatives addressing diabetes, conducted in the EMR, delivered by healthcare professionals or multidisciplinary healthcare teams, and utilized TPE components and/or constructs. Data extraction included self-management outcomes of diabetes mellitus and the country of intervention. Effect sizes were computed for all outcomes. RESULTS: 24 articles, including TPE constructs (knowledge, skills, and confidence) or components (goal setting, action planning, shared decision-making), were included in the analysis. Most articles were randomized controlled trials (n = 14). Workshops and educational sessions in group settings were the most common modality of TPE interventions (n = 18). Results were reported based on self-management outcomes: [1] self-care [2], anthropometric and lifestyle, and [3] biological outcomes. The combination of knowledge and confidence (n = 8), and goal setting (n = 8) were the most reported combinations of the patient competency profile and TPE components, respectively. Most studies (n = 18) reported on self-care outcomes, such as general or specific diet adherence, blood glucose monitoring, foot care, and medication adherence, with effect sizes ranging from small to large. 16 articles also reported on biological measures (glycemic, lipid profile, and blood pressure measurements), 11 on anthropometric outcomes (body mass index-BMI, weight, and waist circumference), 4 on dietary outcomes, and 4 on physical activity outcomes. Mixed effect sizes were observed for anthropometric and biological outcomes, with most studies revealing small effect sizes for changes in BMI, weight, and blood lipids. In contrast, large and significant effect sizes for waist circumference, HbA1c, and fasting blood glucose were noted. CONCLUSION: Despite varying effect sizes for most outcomes, TPE interventions in the EMR showed significant improvements in several diabetes self-management outcomes, including waist circumference, HbA1c, and fasting blood glucose. TPE components and constructs were more prevalent with significant improvements and considerable effect in self-care and biological outcomes, particularly when the TPE constructs were utilized in combinations of two or more. PROSPERO, registration number CRD42024601438. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-24721-w.