Lifestyle interventions for type 2 diabetes management among migrants and ethnic minorities living in industrialized countries: a systematic review and meta-analyses
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Date
2021
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BMJ Open Diab Res Care
Abstract
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 (I2>50%), nand 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.
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This article is published by BMJ Open Diab Res Care,2021 and is also available at 10.1136/bmjdrc-2020-001924
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BMJ Open Diab Res Care