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Health system interventions for adults with type 2 diabetes in low- and middle-income countries: A systematic review and meta-analysis

Author

Listed:
  • David Flood
  • Jessica Hane
  • Matthew Dunn
  • Sarah Jane Brown
  • Bradley H Wagenaar
  • Elizabeth A Rogers
  • Michele Heisler
  • Peter Rohloff
  • Vineet Chopra

Abstract

Background: Effective health system interventions may help address the disproportionate burden of diabetes in low- and middle-income countries (LMICs). We assessed the impact of health system interventions to improve outcomes for adults with type 2 diabetes in LMICs. Methods and findings: We searched Ovid MEDLINE, Cochrane Library, EMBASE, African Index Medicus, LILACS, and Global Index Medicus from inception of each database through February 24, 2020. We included randomized controlled trials (RCTs) of health system interventions targeting adults with type 2 diabetes in LMICs. Eligible studies reported at least 1 of the following outcomes: glycemic change, mortality, quality of life, or cost-effectiveness. We conducted a meta-analysis for the glycemic outcome of hemoglobin A1c (HbA1c). GRADE and Cochrane Effective Practice and Organisation of Care methods were used to assess risk of bias for the glycemic outcome and to prepare a summary of findings table. Of the 12,921 references identified in searches, we included 39 studies in the narrative review of which 19 were cluster RCTs and 20 were individual RCTs. The greatest number of studies were conducted in the East Asia and Pacific region (n = 20) followed by South Asia (n = 7). There were 21,080 total participants enrolled across included studies and 10,060 total participants in the meta-analysis of HbA1c when accounting for the design effect of cluster RCTs. Non-glycemic outcomes of mortality, health-related quality of life, and cost-effectiveness had sparse data availability that precluded quantitative pooling. In the meta-analysis of HbA1c from 35 of the included studies, the mean difference was −0.46% (95% CI −0.60% to −0.31%, I2 87.8%, p

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pmed00:1003434
    DOI: 10.1371/journal.pmed.1003434
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    References listed on IDEAS

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    3. Jamabhorn Jaipakdee & Wiroj Jiamjarasrangsi & Vitool Lohsoonthorn & Somrat Lertmaharit, 2015. "Effectiveness of a self‐management support program for Thais with type 2 diabetes: Evaluation according to the RE‐AIM framework," Nursing & Health Sciences, John Wiley & Sons, vol. 17(3), pages 362-369, September.
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    1. 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.
    2. Rocío Romero-Castillo & Manuel Pabón-Carrasco & Nerea Jiménez-Picón & José Antonio Ponce-Blandón, 2022. "Effects of a Diabetes Self-Management Education Program on Glucose Levels and Self-Care in Type 1 Diabetes: A Pilot Randomized Controlled Trial," IJERPH, MDPI, vol. 19(23), pages 1-13, December.

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