Effectiveness and safety of self-management interventions for improving glycemic control and health-related quality-of-life among adults with type 2 diabetes mellitus in sub-Saharan Africa: a systematic review and meta-analysis

Carter, Naomi; Nalbant, Gamze; Chahal, Prit; Chattopadhyay, Kaushik

Abstract

Objective:

To assess and synthesize evidence on the effectiveness and safety of self- management interventions for improving glycemic control and health-related quality-of-life (HRQoL) among adults with type 2 diabetes mellitus (T2DM) in sub-Saharan Africa.

Introduction:

There has been a rapid increase in the prevalence of T2DM in sub-Saharan Africa. Lifestyle related risk factors require self-management strategies, and these must be tailored to context. Several randomized controlled trials (RCTs) evaluating T2DM self- management interventions in sub-Saharan Africa have been conducted. Inclusion criteria: This systematic review included RCTs assessing the effectiveness and safety of self-management interventions among adults with T2DM in sub-Saharan Africa, where the self-management intervention matched at least one category of the practical systematic review of self-management support for long-term conditions (PRISMS) taxonomy.

Methods:

The following databases were searched from inception until 14th January 2023: MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Directory of Open Access Journals, EthOS, and ProQuest Dissertations and Theses. Global Health (EBSCO) was searched from inception until 8th June 2021. OpenGrey was searched from inception until its archive date of 1st December 2020. Two independent reviewers conducted title and abstract screening, full text screening, data extraction, and critical appraisal. Disagreements were resolved through discussion or with a third reviewer. Data synthesis was conducted narratively, followed by meta-analysis where feasible. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach for assessing the certainty of evidence was applied.

Results:

From 2699 records identified, 18 and 14 RCTs were included in the systematic review and meta-analysis, respectively. Interventions included broad self-management education programs, peer support, exercise interventions with education, nutrition education, educational text-messaging, and blood glucose self-monitoring support. Only 4 studies were assigned a ‘yes’ for more than half of the criteria in the standardized JBI critical appraisal tool for RCTs. Compared to control, self-management interventions did not significantly reduce glycated hemoglobin (HbA1c) at three months (302 participants, mean difference [MD] -6.0 mmol/mol, 95% confidence interval [CI] -17.5, 5.4; very low certainty on GRADE assessment) or 12 months (1504 participants, MD -3.7 mmol/mol, 95% CI -8.2, 0.7; moderate certainty on GRADE assessment). HbA1c was significantly reduced at 6 months (671 participants, MD -8.1mmol/mol, 95% CI -10.7, -5.4; low certainty on GRADE 4 assessment). Four studies assessed HRQoL but only one demonstrated an improvement (2205 participants). Three studies reported no adverse events in relation to the trial interventions (1217 participants), whilst in the remainder it was not reported. There did not appear to be clinically significant effects on body mass index, lipid profile, and systolic or diastolic blood pressure. The evidence was mixed for weight and waist circumference.

Conclusions:

Self-management interventions for adults living with T2DM in sub-Saharan Africa may produce a clinically significant improvement in glycemic control at 6 months, but this may wane in the longer-term. There was not convincing evidence for a benefit of these interventions on HRQoL but reporting on this outcome measure was limited. There were insufficient data on adverse events to draw conclusions

Citation

Carter, N., Nalbant, G., Chahal, P., & Chattopadhyay, K. (in press). Effectiveness and safety of self-management interventions for improving glycemic control and health-related quality-of-life among adults with type 2 diabetes mellitus in sub-Saharan Africa: a systematic review and meta-analysis. JBI Evidence Synthesis, 22(9), 1715-1788. https://doi.org/10.11124/JBIES-23-00273

• Journal Article Type: Article
• Acceptance Date: Feb 22, 2024
• Online Publication Date: Jun 24, 2024
• Deposit Date: Feb 28, 2024
• Publicly Available Date: Jul 24, 2024
• Journal: JBI Evidence Synthesis
• Electronic ISSN: 2689-8381
• Publisher: Wolters Kluwer
• Peer Reviewed: Peer Reviewed
• Volume: 22
• Issue: 9
• Pages: 1715-1788
• DOI: https://doi.org/10.11124/JBIES-23-00273
• Public URL: https://nottingham-repository.worktribe.com/output/31889712
• Publisher URL: https://journals.lww.com/jbisrir/fulltext/9900/effectiveness_and_safety_of_self_management.320.aspx