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Lifestyle Interventions to Improve Glycemic Control in Adults with Type 2 Diabetes Living in Low-and-Middle Income Countries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCTs)

Author

Listed:
  • Grainne O’Donoghue

    (School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland)

  • Cliona O’Sullivan

    (School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland)

  • Isabelle Corridan

    (School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland)

  • Jennifer Daly

    (School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland)

  • Ronan Finn

    (School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland)

  • Kathryn Melvin

    (School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland)

  • Casey Peiris

    (School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia)

Abstract

Alongside glucose lowering therapy, clinical guidelines recommend lifestyle interventions as cornerstone in the care of people living with type 2 diabetes (T2DM). There is a specific need for an up-to-date review assessing the effectiveness of lifestyle interventions for people with T2DM living in low-and-middle income countries (MICs). Four electronic databases were searched for RCTs published between 1990 and 2020. T2DM, lifestyle interventions, LMICs and their synonyms were used as search terms. Data codebooks were developed and data were extracted. Narrative synthesis and meta-analysis were conducted using random effects models to calculate mean differences (MD) and standardized mean differences (SMD) and 95% confidence intervals (CI). Of 1284 articles identified, 30 RCTs ( n = 16,670 participants) met the inclusion criteria. Pooled analysis revealed significant improvement in HBA1c (MD −0.63; CI: −0.86, −0.40), FBG (SMD −0.35; CI: −0.54, −0.16) and BMI (MD −0.5; CI: −0.8, −0.2). In terms of intervention characteristics, those that included promoted self-management using multiple education components (e.g., diet, physical activity, medication adherence, smoking cessation) and were delivered by healthcare professionals in a hospital/clinic setting were deemed most effective. However, when interpreting these results, it is important to consider that most included studies were evaluated as being of low quality and there was a significant amount of intervention characteristics heterogeneity. There is a need for further well-designed studies to inform the evidence base on which lifestyle interventions are most effective for glycemic control in adults with T2DM living in LMICs.

Suggested Citation

  • Grainne O’Donoghue & Cliona O’Sullivan & Isabelle Corridan & Jennifer Daly & Ronan Finn & Kathryn Melvin & Casey Peiris, 2021. "Lifestyle Interventions to Improve Glycemic Control in Adults with Type 2 Diabetes Living in Low-and-Middle Income Countries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCT," IJERPH, MDPI, vol. 18(12), pages 1-16, June.
  • Handle: RePEc:gam:jijerp:v:18:y:2021:i:12:p:6273-:d:572291
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    References listed on IDEAS

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    1. Shaofan Chen & Bo Burström & Vibeke Sparring & Dongfu Qian & Kristina Burström, 2019. "Differential Impact of an Education-Based Intervention for Patients with Type 2 Diabetes Mellitus in Rural China," IJERPH, MDPI, vol. 16(15), pages 1-12, July.
    2. Ye Li & Meihong Xu & Rui Fan & Xiaotao Ma & Jiaojiao Gu & Xiaxia Cai & Rui Liu & Qihe Chen & Jinwei Ren & Ruixue Mao & Lei Bao & Zhaofeng Zhang & Junbo Wang & Yong Li, 2016. "The Effects of Intensive Nutrition Education on Late Middle-Aged Adults with Type 2 Diabetes," IJERPH, MDPI, vol. 13(9), pages 1-10, September.
    3. David Flood & Jessica Hane & Matthew Dunn & Sarah Jane Brown & Bradley H Wagenaar & Elizabeth A Rogers & Michele Heisler & Peter Rohloff & Vineet Chopra, 2020. "Health system interventions for adults with type 2 diabetes in low- and middle-income countries: A systematic review and meta-analysis," PLOS Medicine, Public Library of Science, vol. 17(11), pages 1-19, November.
    4. Okon Essien & Akaninyene Otu & Victor Umoh & Ofem Enang & Joseph Paul Hicks & John Walley, 2017. "Intensive Patient Education Improves Glycaemic Control in Diabetes Compared to Conventional Education: A Randomised Controlled Trial in a Nigerian Tertiary Care Hospital," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-12, January.
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    Cited by:

    1. Thomas Ernst Dorner & Christian Lackinger & Sandra Haider & Katharina Viktoria Stein, 2021. "Lifestyle Parameters in Patients with Diabetes Mellitus and in the General Adult Population—Trends over Five Years: Results of the Austrian National Health Interview Series," IJERPH, MDPI, vol. 18(18), pages 1-13, September.
    2. Mi-Kyoung Cho & Mi Young Kim, 2021. "Self-Management Nursing Intervention for Controlling Glucose among Diabetes: A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 18(23), pages 1-19, December.

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