Experiences of type 2 diabetes stigma in healthcare settings: a mixed-methods systematic review

International consensus highlights the urgent need to address diabetes stigma in healthcare. This systematic review synthesised qualitative and quantitative evidence to provide context-specific insights into type 2 diabetes (T2D) stigma in healthcare settings. We searched PubMed, CINAHL, and PsycINFO (from inception to December 2025). Data were analysed thematically using a hybrid deductive-inductive coding approach guided by the Health Stigma and Discrimination Framework (HSDF), examining four key domains of stigma: manifestations, drivers/facilitators, markers, and impacts. Sixty-one articles from 32 countries were included. Individuals with T2D perceived, experienced, anticipated, and internalised T2D stigma, perpetuated through healthcare professionals' (HCPs') communication, attitudes, and practices. T2D stigma was driven by negative emotional reactions, stereotypes, authoritarianism, and lack of knowledge; and facilitated by overly simplistic care models and healthcare-related media misrepresentation. Negative impacts spanned psychosocial well-being, health-seeking behaviours, quality of care, and interpersonal relationships with HCPs. People with T2D called for HCPs and system-level reforms to foster stigma-free T2D healthcare. These findings strengthen the understanding of T2D stigma in healthcare, including its pervasiveness and consequences, and reveal actionable drivers and facilitators, which can be used to develop targeted interventions and guidance towards stigma-free T2D care.