Primary Care Management of Type 2 Diabetes Mellitus in Saudi Arabia: A Systematic Review of Clinical Outcomes and Healthcare Challenges

Abstract

Background: Type 2 diabetes mellitus (T2DM) represents a major public health challenge in Saudi Arabia, with prevalence rates among the highest globally (23.1% age-standardized) and only 22.5% of patients achieving adequate glycemic control (HbA1c <7%). Primary healthcare centers serve as the cornerstone of diabetes management in the Kingdom, yet significant gaps persist in translating available resources into optimal clinical outcomes.
Objective: This systematic review synthesizes evidence on clinical outcomes and healthcare challenges associated with primary care management of T2DM in Saudi Arabia, identifying barriers to optimal care and effective interventional strategies.
Methods: A comprehensive systematic search was conducted across PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for studies published between 2021-2026. Following PRISMA 2020 guidelines, 24 studies met eligibility criteria and were included. Quality assessment utilized JBI checklists, Newcastle-Ottawa Scale, and Cochrane RoB 2. Due to substantial heterogeneity, a narrative synthesis was performed.
Results: Glycemic control remains persistently suboptimal, with mean HbA1c levels ranging from 7.69% to 10.47% and only 15.7-22.5% achieving HbA1c <7%. Microvascular complications affected 55.1% of patients (nephropathy 80.2%, retinopathy 32.7%, neuropathy 8.4%), with cardiovascular disease prevalence at 18%. Patient-level barriers included low medication adherence (46.7%), poor lifestyle modification adherence, and significant knowledge gaps. Clinical inertia was prevalent, with only 48% of family physicians aware of therapeutic inertia and 31.6% unfamiliar with the concept. System-level barriers included lack of multidisciplinary teams (68.5%), time constraints (53.5%), and high workload (52.0%). Promising interventions—patient activation-tailored programs, hybrid telemedicine models, and health coaching—demonstrated significant HbA1c reductions (2.59% mean reduction).
Conclusion: Primary care T2DM management in Saudi Arabia is suboptimal due to multifaceted barriers at patient, physician, and system levels. Multi-level evidence-based strategies, including provider education, team-based care, patient activation, and digital health integration, are urgently needed to improve outcomes and achieve Saudi Vision 2030 health objectives.