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Lifestyle interventions for type 2 diabetes management among migrants and ethnic minorities living in industrialized countries: A systematic review and meta-analyses

journal contribution
posted on 14.10.2021, 05:01 by Lal RawalLal Rawal, Berhe W Sahle, Ben J Smith, Kie Kanda, Ebenezer Owusu-Addo, Andre MN Renzaho
The objective of this systematic review was to determine the effectiveness of lifestyle interventions to improve the management of type 2 diabetes mellitus (T2DM) among migrants and ethnic minorities. Major searched databases included MEDLINE (via PubMed), EMBASE (via Ovid) and CINAHL. The selection of studies and data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the meta-analysis, significant heterogeneity was detected among the studies (I 2 >50%), and hence a random effects model was used. Subgroup analyses were performed to compare the effect of lifestyle interventions according to intervention approaches (peer-led vs community health workers (CHWs)-led). A total of 17 studies were included in this review which used interventions delivered by CHWs or peer supporters or combination of both. The majority of the studies assessed effectiveness of key primary (hemoglobin (HbA1c), lipids, fasting plasma glucose) and secondary outcomes (weight, body mass index, blood pressure, physical activity, alcohol consumption, tobacco smoking, food habits and healthcare utilization). Meta-analyses showed lifestyle interventions were associated with a small but statistically significant reduction in HbA1c level (-0.18%; 95% CI-0.32% to-0.04%, p=0.031). In subgroup analyses, the peer-led interventions showed relatively better HbA1c improvement than CHW-led interventions, but the difference was not statistically significant (p=0.379). Seven studies presented intervention costs, which ranged from US$131 to US$461 per participant per year. We conclude that lifestyle interventions using either CHWs or peer supporters or a combination of both have shown modest effectiveness for T2DM management among migrants of different background and origin and ethnic minorities. The evidence base is promising in terms of developing culturally appropriate, clinically sound and cost-effective intervention approaches to respond to the growing and diverse migrants and ethnic minorities affected by diabetes worldwide.

History

Volume

9

Issue

1

Start Page

1

End Page

18

Number of Pages

18

eISSN

2052-4897

ISSN

2052-4897

Location

England

Publisher

B M J Group

Publisher License

CC BY-NC

Additional Rights

CC BY-NC 4.0

Language

eng

Peer Reviewed

Yes

Open Access

Yes

Acceptance Date

08/03/2021

External Author Affiliations

Kwame Nkrumah University of Science and Technology, Ghana; Western Sydney University; University of Melbourne; The University of Sydney School of Public Health

Era Eligible

Yes

Medium

Print

Journal

BMJ Open Diabetes Research and Care

Article Number

001924