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Aims: To describe how people of African descent perceive and understand type 2 diabetes, and to examine the impact of their perceptions and beliefs on the uptake of diet, exercise, weight control and adherence to medication recommendations., Design: Systematic literature review of quantitative and qualitative studies., Data Sources: We searched MEDLINE, CINAHL Complete, Psych INFO, Academic Search Premier, Education Research Complete, Web of Science and Scopus, World Health Organization (WHO), Diabetes UK and American Diabetes Association for articles published from January 1999 to December 2019., Review Methods: Informed by the PRISMA guidelines, we independently reviewed titles and abstracts, identified articles for full-text review that met inclusion criteria, conducted a quality assessment and extracted data. Findings were synthesized using a thematic approach., Results: Twenty-six studies met the inclusion criteria. Knowledge and understanding of diabetes were poor. Beliefs and behaviours about diet, exercise, weight and health care were erroneous. Most diabetic participants could not recognize diabetes symptoms, failed to take their diagnosis seriously and did not adhere to medication recommendations. The resultant effect was an increased risk of complications with undesirable outcomes., Conclusion: Poor diabetes perceptions are linked to negative consequences and may be responsible for poorer outcomes among people of African descent. This review highlights the need to consider this population's beliefs and practices in structuring culturally sensitive programmes for diabetes management., Impact: This systematic literature review is the first to exclusively explore perceptions of people of African descent in relation to diabetes. It is important to consider people of African descents' diabetes perceptions and practices before formulating interventions for their diabetes management., (© 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)