Abstract
BackgroundType 2 Diabetes Mellitus (T2DM) is reported to affect one in 11 adults worldwide, with over 80% of T2DM patients residing in low-to-middle-income countries. Health systems play an integral role in responding to this increasing global prevalence, and are key to ensuring effective diabetes management. We conducted a systematic review to examine the health system-level factors influencing T2DM awareness, treatment, adherence, and control.Methods and findingsA protocol for this study was published on the PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42016048185). Studies included in this review reported the effects of health systems factors, interventions, policies, or programmes on T2DM control, awareness, treatment, and adherence. The following databases were searched on 22 February 2017: Medline, Embase, Global health, LILACS, Africa-Wide, IMSEAR, IMEMR, and WPRIM. There were no restrictions on date, language, or study designs. Two reviewers independently screened studies for eligibility, extracted the data, and screened for risk of bias. Thereafter, we performed a narrative synthesis. A meta-analysis was not conducted due to methodological heterogeneity across different aspects of included studies. 93 studies were included for qualitative synthesis; 7 were conducted in LMICs. Through this review, we found two key health system barriers to effective T2DM care and management: financial constraints faced by the patient and limited access to health services and medication. We also found three health system factors that facilitate effective T2DM care and management: the use of innovative care models, increased pharmacist involvement in care delivery, and education programmes led by healthcare professionals.ConclusionsThis review points to the importance of reducing, or possibly eliminating, out-of-pocket costs for diabetes medication and self-monitoring supplies. It also points to the potential of adopting more innovative and integrated models of care, and the value of task-sharing of care with pharmacists. More studies which identify the effect of health system arrangements on various outcomes, particularly awareness, are needed.
Highlights
The 2015 International Diabetes Federation’s Diabetes Atlas [1] reported that 415 million people worldwide, or one in 11 adults, has diabetes, with most having Type 2 Diabetes Mellitus (T2DM) [1]
We found two key health system barriers to effective T2DM care and management: financial constraints faced by the patient and limited access to health services and medication
This review points to the importance of reducing, or possibly eliminating, out-of-pocket costs for diabetes medication and self-monitoring supplies
Summary
The 2015 International Diabetes Federation’s Diabetes Atlas [1] reported that 415 million people worldwide, or one in 11 adults, has diabetes, with most having Type 2 Diabetes Mellitus (T2DM) [1]. No systematic review assembles the evidence appraising the impact of health systems on management of type 2 diabetes mellitus (T2DM). To address this gap, we systematically review the literature examining the health system-level factors influencing T2DM awareness, treatment, adherence, and control, and make recommendations for future research and policy considerations. Type 2 Diabetes Mellitus (T2DM) is reported to affect one in 11 adults worldwide, with over 80% of T2DM patients residing in low-to-middle-income countries. We conducted a systematic review to examine the health system-level factors influencing T2DM awareness, treatment, adherence, and control
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