Facilitators and barriers influencing the implementation of type 2 diabetes remission programmes: a qualitative meta-synthesis from a multi-stakeholder perspective

Although type 2 diabetes (T2D) remission has emerged as a promising therapeutic goal, its implementation in real-world settings faces considerable challenges. Understanding the perspectives of multiple stakeholders is essential to address these implementation challenges. This meta-synthesis aims to identify and synthesise facilitators and barriers to the implementation of T2D remission programmes from the perspectives of different stakeholders. Eleven databases were searched from inception to August 1, 2026. Two reviewers independently screened studies, extracted data, and appraised methodological quality using the 10-item Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data were analysed and synthesised using thematic analysis, with findings mapped to the Capability, Opportunity, Motivation–Behaviour (COM-B) model. A total of 22 studies involving 277 patients and 237 stakeholders were included. Key facilitators for patient engagement in T2D remission included perceived benefits of remission, accessible and sustained support networks, and the convenience enabled by digital health tools. Major barriers included limited health literacy, restrictive sociocultural norms and dietary habits, and negative emotions. For stakeholders, key facilitators were multidisciplinary collaboration, personalised intervention approaches, supportive policies, and growing recognition of the value of T2D remission. Barriers included inconsistent understanding of T2D remission, variations in professional capacity and roles, resource constraints, and uncertainty about intervention effectiveness. These findings, interpreted through the COM-B framework, identified multi-level factors shaping the implementation and sustainability of T2D remission programmes. Sustainable implementation of T2D remission programmes requires patient-centred approaches that promote accurate understanding of remission and positive patient experiences, strengthened healthcare provider capacity through training and multidisciplinary collaboration, and adaptation of interventions to local contexts. These findings highlight the importance of stakeholder-informed strategies to enhance patient engagement and guide the future design and implementation of T2D remission programmes. The review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD420251037259.