The effect of lifestyle interventions on cognitive function in patients with type 2 diabetes: a systematic review and meta-analysis

To systematically evaluate the effects of lifestyle interventions on cognitive function in patients with type 2 diabetes mellitus (T2DM). A search of PubMed, Web of Science, EMBASE, Cochrane Library, CNKI, and Wangfang was conducted for randomized controlled trials (RCTs) published between the establishment of the database and April 2025. Fixed-effects or random-effects models were employed for meta-analysis, with subgroup analysis by measurement tool, intervention type, duration, and cognitive status. Meta-analysis, sensitivity analysis, and publication bias assessments were performed by Stata 15.0. Twenty-seven eligible studies with a total of 2314 T2DM patients were included. A meta-analysis revealed that the combined effect size of lifestyle interventions on global cognitive function improvement was significant (SMD = 1.66, 95% CI: 1.07 to 2.25, P < 0.001). The following four factors had significant effects on the global cognitive function: country (China [SMD = 2.16, 95% CI: 1.44 to 2.88, P < 0.001], Iran [SMD = 1.10, 95% CI: 0.07 to 2.12, P = 0.036], Japan [SMD = 0.80, 95% CI: 0.15 to 1.46, P = 0.017]), intervention type (exercise [SMD = 1.52, 95% CI: 0.90 to 2.14, P < 0.001], diet [SMD = 4.27, 95% CI: 1.74 to 6.80, P = 0.001], comprehensive lifestyle [SMD = 0.77, 95% CI: 0.05 to 1.48, P = 0.037]), intervention duration (< 12 months [SMD = 2.19, 95% CI: 1.50 to 2.87, P < 0.001]), and cognitive status (patients with mild cognitive impairment [SMD = 1.81, 95% CI: 1.20 to 2.43, P < 0.001], patients with no mild cognitive impairment [SMD = 1.45, 95% CI: 0.41 to 2.49, P = 0.006]). Lifestyle interventions may improve the global cognitive function of patients with T2DM. Studies with larger sample sizes and higher quality are expected to yield robust and definitive conclusions.