Abstract
Background: The burden of type 2 diabetes mellitus (T2DM) is increasing in low- and middle-income countries, including sub-Sahara Africa (SSA). However, awareness of and access to T2DM diagnosis and care remain low in SSA, leading to delayed treatment, early morbidity, and mortality. Particularly in rural settings with long distances to health care facilities, community-based care models may contribute to increased timely diagnosis and care. This scoping review aims to summarize and categorize existing models of community-based care for T2DM among non-pregnant adults in SSA, and to synthesize the evidence on acceptance, clinical outcomes, and engagement in care. Method and analysis: This review will follow the framework suggested by Arskey and O'Malley, which has been further refined by Levac et al. and the Joanna Briggs Institute. Electronic searches will be performed in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus, supplemented with backward and forward citation searches. We will include cohort studies, randomized trials and case-control studies that report cases of non-pregnant individuals diagnosed with T2DM in SSA who receive a substantial part of care in the community. Our outcomes of interest will be model acceptability, blood sugar control, end organ damage, and patient engagement in care. A narrative analysis will be conducted, and comparisons made between community-based and facility-based models, where within-study comparison is reported. Conclusion: Care for T2DM has become a global health priority. Community-based care may be an important add-on approach especially in populations with poor access to health care facilities. This review will inform policy makers and program implementers on different community-based models for care of T2DM in SSA, and critically appraise their acceptability and clinical outcomes. It will further identify evidence gaps and future research priorities in community-based T2DM care.
Highlights
There are about 463 million people living with diabetes mellitus, representing 9.3% of the global population aged 20 – 79 years.[1]
This number is projected to rise to 700 million people in 2045.1 Approximately 95% of diabetes mellitus cases are due to type 2 diabetes mellitus (T2DM), characterized by chronic hyperglycemia resulting from a decrease in insulin secretion, or insulin resistance.[2,3]
In sub-Saharan Africa (SSA), 20 million people currently live with diabetes with a projected increase to 47 million people by 2045.5
Summary
Please elaborate further and explain why the review questions/objectives lend themselves to a scoping review approach. The authors may consider rephrasing the Introduction section to help the readers understand the contributions of this study in an explicit manner. Some parts of the content, such as related work, could be moved to a new related work section in particular up-to-date published related work. In SSA there is a wide range of community-based care for diabetes care including for nonpregnant women - for example, in South Africa and other southern countries where most of those models are operating in the community health centers (CHCs) (facility-based) via CHWs in the community. I am wondering in the search strategy, how many articles addressing the communitybased models in those facilities would be missed from these communities?
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