THE GROWING ROLE OF FAMILY MEDICINE IN DIABETES MANAGEMENT AND CONTROL: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Diabetes affects approximately 830 million adults globally, yet endocrinology specialist capacity lags behind demand. Family medicine is positioned to expand its endocrine care role, but no prior synthesis has quantified the collective impact of primary care–anchored endocrine strategies. To estimate the pooled effect of family medicine–anchored interventions defined as interventions implemented within general practice/family medicine/primary care services, including team-based delivery on glycated hemoglobin (HbA1c) and to develop a practical expansion framework. PRISMA 2020–guided systematic review and random-effects meta-analysis of PubMed/MEDLINE (2011–2025). Eligible studies evaluated primary care–led endocrine interventions in adults with diabetes. Risk of bias was assessed using the Revised Cochrane Risk-of-Bias tool. Subgroup analyses examined intervention categories. Fifteen studies met inclusion criteria; 13 contributed to the pooled analysis (N = 13,554). The pooled HbA1c mean difference was −0.22 percentage points (95% CI: −0.35 to −0.08; I²= 75%). The largest effect was from an intensive primary care–led weight management program (−0.85%; 95% CI: −1.10 to −0.59), achieving 46% diabetes remission. Technology-enabled and behavioral interventions showed variable but favorable effects. Family medicine interventions produce a modest but significant HbA1c reduction, with larger effects from intensive metabolic and technology-enabled strategies. A four-pillar framework team-based care, behavior change integration, technology-enabled workflows, and specialist partnership can guide systematic expansion.