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Effectiveness of Multi-level and Multi-domain Interventions to Improve Glycemic Control in US Racial/Ethnic Minority Populations: A Systematic Review and Meta-analysis

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posted on 2024-08-27, 21:06 authored by Eli M. Falk, Erin M. Staab, Amber N. Deckard, Sofia I. Uranga, Nikita C. Thomas, Wen Wan, Andrew J Karter, Elbert S. Huang, Monica E. Peek, Neda Laiteerapong

Background: Racial and ethnic disparities in type 2 diabetes outcomes are a major public health concern. Interventions targeting multiple barriers may help address disparities.

Purpose: To conduct a systematic review and meta-analysis of diabetes self-management education interventions (DSME) in minority populations. We hypothesized that interventions addressing multiple levels (individual, interpersonal, community, societal) and/or domains (biological, behavioral, physical/built environment, sociocultural environment, health care system) would have the greatest effect on hyperglycemia.

Data Sources: PubMed, Scopus, CINAHL, PsycINFO (1985-2019).

Study Selection: Randomized controlled trials (RCTs) of DSME interventions among US adults with type 2 diabetes from racial/ethnic minority populations.

Data Synthesis: There were 106 RCTs included. Twenty-five percent (n=27) of interventions were exclusively individual-behavioral, 51% (n=54) were multi-level, 66% (n=70) were multi-domain, and 42% (n=45) were both multi-level and multi-domain. Individual-behavioral interventions reduced percent hemoglobin A1c (HbA1c) by -0.34 (95% CI [-0.46, -0.22], I² = 33%) (-3.7 [-5.0, -2.4] mmol/mol). Multi-level interventions reduced percent HbA1c by -0.40 (95% CI [-0.51, -0.29], I² = 68%) (-4.4 [-5.6, -3.2] mmol/mol). Multi-domain interventions reduced percent HbA1c by -0.39 (95% CI [-0.49, -0.29]), I² = 68%) (-4.3 [-5.4, -3.2] mmol/mol). Interventions that were both multi-level and multi-domain reduced percent HbA1c by -0.43 (95% CI [-0.55, -0.31], I² = 69%) (-4.7 [-6.0, -3.4] mmol/mol).

Limitations: Restricted to RCTs.

Conclusions: Multi-level and multi-domain DSME interventions had a modest impact on HbA1c. Few DSME trials have targeted the community/societal levels or physical environment domain. Future research is needed to evaluate the impact of these interventions on outcomes beyond HbA1c.