{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:57:05Z","timestamp":1791223025722,"version":"4.1.0"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fear of hypoglycaemia (FoH) can interfere with diabetes self-management in adults with type 2 diabetes mellitus (T2DM). Educational and behavioural interventions may address hypoglycaemia-related worry and avoidance, but evidence focused on adults with T2DM remains limited. This systematic review and meta-analysis examined the effects of structured educational and behavioural interventions on FoH in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Nine databases were searched from inception to 31 December 2025 for randomised controlled trials of educational and behavioural interventions addressing FoH or FoH-related outcomes in adults with T2DM. Data were pooled using random-effects models, estimating standardised mean differences (SMDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using Tau\u00b2 and I\u00b2, and a 95% prediction interval was estimated. Small-study effects and additional sensitivity analyses were examined. Risk of bias was assessed using Cochrane RoB 2, and certainty of evidence was assessed using GRADE. The review was registered with PROSPERO (CRD42025630957).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eleven RCTs involving 1,096 participants were included. The exploratory pooled average effect favoured educational and behavioural interventions for reducing FoH (SMD\u2009= \u22121.89; 95% CI \u22122.54 to \u22121.25;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.00001). Heterogeneity was substantial (Tau\u00b2\u2009=\u20091.10; I\u00b2\u2009=\u200995%), and the 95% prediction interval crossed the line of no effect (95% PI \u22124.34 to 0.56), suggesting that effects may differ across future similar studies. Funnel plot asymmetry and Egger\u2019s regression test suggested possible small-study effects. Trim-and-fill findings were estimator-dependent and suggested possible attenuation of the pooled estimate in exploratory analysis. The certainty of evidence was very low because of risk of bias, substantial heterogeneity, indirectness, and possible small-study effects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Very low-certainty evidence suggests that structured educational and behavioural interventions may reduce FoH in adults with T2DM; however, the magnitude and generalisability of this effect remain uncertain. Further RCTs with standardised FoH measures, longer follow-up, and clearer reporting of intervention components and fidelity are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0358881","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:33:37Z","timestamp":1791221617000},"page":"e0358881","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Educational and behavioural interventions for reducing fear of hypoglycaemia in adults with type 2 diabetes: A systematic review and meta-analysis of randomised controlled trials"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3560-2886","authenticated-orcid":true,"given":"Yan","family":"Tang","sequence":"first","affiliation":[{"name":"Universiti Putra Malaysia","place":["Serdang, Selangor, Malaysia"],"department":["Department of Nursing"]},{"name":"Jiangsu Medical College","place":["Yancheng, Jiangsu, China"],"department":["Faculty of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjun","family":"Zhou","sequence":"additional","affiliation":[{"name":"Nanjing University","place":["Yancheng, Jiangsu, China"],"department":["Department of Endocrinology, Yancheng No.1 People\u2019s Hospital, Affiliated Hospital of Medical School"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9016-3414","authenticated-orcid":true,"given":"Wan Ying","family":"Gan","sequence":"additional","affiliation":[{"name":"Universiti Putra Malaysia","place":["Serdang, Selangor, Malaysia"],"department":["Department of Nutrition"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim Geok","family":"Soh","sequence":"additional","affiliation":[{"name":"Universiti Putra Malaysia","place":["Serdang, Selangor, Malaysia"],"department":["Department of Sports Studies"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2404-828X","authenticated-orcid":true,"given":"Kim Lam","family":"Soh","sequence":"additional","affiliation":[{"name":"Universiti Putra Malaysia","place":["Serdang, Selangor, Malaysia"],"department":["Department of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"pone.0358881.ref001","doi-asserted-by":"crossref","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"H Sun","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"issue":"23","key":"pone.0358881.ref002","doi-asserted-by":"crossref","DOI":"10.1111\/jcmm.70240","article-title":"Role of autophagy in type 2 diabetes mellitus: the metabolic 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