CC BY-NC 4.0 Attribution-NonCommercial 4.0 InternationalAlanazi, Maha MouidhFellas, AntoniBridge, PascaleAcharya, ShamasunderSantos, DerekSculley, DeanGirones, XavierCoda, Andrea2025-11-202025-11-16Alanazi, M.M., Fellas, A., Bridge, P., Acharya, S., Santos, D., Sculley, D., Girones, X. and Coda, A. (2025) ‘Enablers and barriers of e-learning utilising smart technologies in type 2 diabetes care for clinicians: a systematic review’, BMJ Open, 15(11), p. e103328. Available at: https://doi.org/10.1136/bmjopen-2025-103328.2044-60552044-6055https://eresearch.qmu.ac.uk/handle/20.500.12289/14499https://doi.org/10.1136/bmjopen-2025-103328Derek Santos - ORCID: 0000-0001-9936-715X https://orcid.org/0000-0001-9936-715XObjectives Continuous Glucose Monitoring (CGM) supports Type 2 Diabetes (T2D) management, but healthcare professionals (HCPs) often face challenges interpreting data. E-learning platforms can enhance knowledge, skills and confidence. This systematic review identified enablers and barriers to e-learning for CGM interpretation. Design Systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data sources PubMed, Ovid MEDLINE, Ovid Embase, Cochrane Library, Scopus, Web of Science and CINAHL were searched on 7 February 2024. Eligibility criteria for selecting studies Studies of HCPs using e-learning for T2D management were included, both comparative and non-comparative. Outcomes included enablers and barriers. Eligible designs were randomised, quasi-experimental, controlled before-and-after and observational studies. No restrictions on setting or language; conference abstracts included if full text was available Data extraction and synthesis Two reviewers independently screened and extracted data using a predefined form; disagreements were resolved by a third reviewer. Thematic analysis identified key enablers and barriers. Methodological quality was assessed using the Downs and Black checklist, and findings were synthesised narratively. Results Four studies met inclusion criteria, including 6790 participants (physicians, nurses, midwives and medical residents). E-learning improved knowledge and skills. Emami et al reported increased knowledge of T2D diagnosis and treatment (p=0.001), while Okuroğlu and Alpar found improvements in diabetes care knowledge and skills (p<0.001). Harris et al noted enhanced self-reported performance (p=0.03) and 84% satisfaction. Enablers included flexibility and accessibility, while barriers involved time constraints, resistance to change and methodological limitations (self-selection bias, lack of blinding). Study quality ranged from fair (three studies) to poor (one study). Conclusion Based on current evidence, it is unclear if e-learning can significantly enhance HCPs’ knowledge, skills and confidence in T2D management. Barriers such as time constraints and resistance to change remain, and the limited number and quality of studies restrict the generalisability of these findings. E-learning may offer potential benefits, but further robust randomised controlled trials are needed to evaluate long-term outcomes and strategies to overcome these challenges.e103328en© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.https://creativecommons.org/licenses/by-nc/4.0/Article10.1136/bmjopen-2025-103328