FRI650 Effectiveness Of Non-pharmacological Strategies In The Management Of Type 2 Diabetes In Primary Care: A Systematic Review And Network Meta-analysis

Abstract

Abstract Disclosure: R.G. Occhiuto: None. L. Banzato: None. A.L. Mendes: None. F. Bolfi: None. V.D. Nunes-Nogueira: None. Introduction: Despite the increasing number of drugs and various guidelines on the management of type 2 diabetes mellitus (T2DM), several patients continue with the disease uncontrolled. There are several non-pharmacological treatments available for managing T2DM, but various of them have never been compared directly to determine the best strategies. Objective: This study has evaluated the comparative effects of non-pharmacological strategies in the management of T2DM in primary care or community settings. Methods and Analysis: We have performed a systematic review and network meta-analysis (NMA) and have include randomized controlled trials if non-pharmacological strategies in the management of type 2 diabetes were applied in adult patients with T2DM in primary care. The primary outcome was glycemic control (glycated hemoglobin [HbA1c] [%]). We have developed search strategies for Embase, Medline, Latin American and Caribbean Health Sciences Literature, Cochrane Central Register of Controlled Trials, Trip database, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Australasian Medical Index, and Chinese Biomedical Literature Database. Four reviewers have assessed the studies for their eligibility and their risk of bias in pairs and independently. A NMA have been performed using Stata Statistical Software 17 (Stata Statistical Software: Release 17. College Station, TX, StataCorp LLC, USA). Results: After removing duplicates, the search strategies yielded 4314 studies. After a thorough evaluation of the references, 129 studies encompassing a total of 35975 individuals have been included in this review. Twenty and three strategies were founded. The most frequent strategy was diabetes self-management and support (DSMES) (60%), followed by diabetes self-management education (22%), self-monitoring of blood glucose (7%) and health coach (5). The most frequent comparator has been usual care (92%). Regarding relative rankings of treatments, the NMA has showed that nutritional therapy plate method has a 37.6% probability of being the best treatment in terms of HbA1c reduction, followed by DSMES associated with social support (24%) and low-fat diet (19.6%). Conclusion: This review has founded 23 non-pharmacological strategies in the management of type 2 diabetes in primary care, being the most frequent DSMES. Grant FAPESP:2021/07229-0 Presentation: Friday, June 16, 2023