<p>Characteristics of included studies.</p>

Risk of bias was assessed using Cochrane RoB 2, and certainty of evidence was assessed using GRADE. The review was registered with PROSPERO (CRD42025630957).</p> <p>Results</p><p>Eleven RCTs involving 1,096 participants were included. The exploratory pooled average effect favoured educational and behavioural interventions for reducing FoH (SMD = −1.89; 95% CI −2.54 to −1.25; <i>p</i> < 0.00001).

Heterogeneity was substantial (Tau² = 1.10; I² = 95%), and the 95% prediction interval crossed the line of no effect (95% PI −4.34 to 0.56), suggesting that effects may differ across future similar studies. Funnel plot asymmetry and Egger’s 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.</p> <p>Conclusion</p><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.</p></div>