Effectiveness and safety of self-management interventions among adults with type 2 diabetes mellitus in sub-Saharan Africa: a systematic review and meta-analysis
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Lifespan and Population Health, School of Medicine, University of Nottingham, United Kingdom
Health Education East Midlands, United Kingdom
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A1532
Background and Objective: There has been a rapid increase in the prevalence of type 2 diabetes (T2DM) in sub-Saharan Africa (SSA). Association with lifestyle factors make self-management strategies an integral part of managing T2DM, and these must be tailored to context. Several randomised controlled trials (RCTs) evaluating T2DM self-management interventions in SSA have been conducted. This systematic review therefore aimed to assess and synthesize evidence on the effectiveness and safety of self-management interventions among adults with T2DM in SSA. Methods: The JBI systematic review methodology was followed. Several databases were searched for published and unpublished RCTs until 31st May 2021. The screening of titles and abstracts and full texts, data extraction and critical appraisal were conducted by two independent reviewers. Disagreements were resolved through Discussion or with a third reviewer. Data synthesis was conducted using narrative synthesis, followed by meta-analysis where feasible. Results: Out of 1452 records identified, 16 and 12 studies were included in the systematic review and meta-analysis, respectively. Only 4 studies were assigned a ‘yes’ for more than half of the criteria in the standardised JBI critical appraisal tool for RCTs. Compared to usual care, self-management interventions did not reduce glycated haemoglobin (HbA1c) at 3 months. HbA1c was reduced at 6 months (490 participants, mean difference -6.45mmol/mol, 95% confidence intervals -9.98, -2.92), but not at 12 months. Three studies assessed health-related quality of life and one demonstrated an improvement (2762 participants). Three studies specifically reported no adverse events in relation to the trial interventions (1230 participants), whilst in the remainder this was not reported. Conclusions: Self-management interventions for adults with T2DM in SSA appear to produce a clinically significant improvement in glycaemic control in the medium-term. Given the limitations of the available evidence and to strengthen the evidence base, high-quality RCTs should be conducted and reported.