Abstract
BackgroundType 2 diabetes presents a major morbidity and mortality burden in the United States. Diabetes self-management education (DSME) is an intervention associated with improved hemoglobin A1c(HbA1c) and quality of life(QOL), and is recommended for all individuals with type 2 diabetes. African-Americans have disproportionate type 2 diabetes morbidity and mortality, yet no prior meta-analyses have examined DSME outcomes exclusively in this population. This systematic review and meta-analysis examined the impact of DSME on HbA1c and QOL in African-Americans compared to usual care.MethodsRandomized controlled trials, cluster-randomized trials, and quasi-experimental interventions were included. 352 citations were retrieved; 279 abstracts were reviewed, and 44 full-text articles were reviewed. Fourteen studies were eligible for systematic review and 8 for HbA1c meta-analysis; QOL measures were too heterogeneous to pool. Heterogeneity of HbA1c findings was assessed with Cochran’s Q and I2.ResultsHbA1c weighted mean difference between intervention and usual care participants was not significant: − 0.08%[− 0.40–0.23];χ2 = 84.79 (p < .001), I2 = 92%, (n = 1630). Four of five studies measuring QOL reported significant improvements for intervention participants.ConclusionsMeta-analysis results showed non-significant effect of DSME on HbA1c in African-Americans. QOL did show improvement and is an important DSME outcome to measure in future trials. Further research is needed to understand effectiveness of DSME on HbA1c in this population.Trial registrationPROSPERO registration: CRD42017057282.
Highlights
Type 2 diabetes presents a major morbidity and mortality burden in the United States
Profound racial and ethnic disparities exist in type 2 diabetes morbidity and mortality in the United States, for African-Americans
An initial search was developed for OVID MEDLINE using keywords, medical subject (MeSH) terms and publication types based on the PICO framework
Summary
Type 2 diabetes presents a major morbidity and mortality burden in the United States. African-Americans have disproportionate type 2 diabetes morbidity and mortality, yet no prior meta-analyses have examined DSME outcomes exclusively in this population. Profound racial and ethnic disparities exist in type 2 diabetes morbidity and mortality in the United States, for African-Americans. African-Americans are less likely to have controlled HbA1c than non-Hispanic whites [2], are more likely to develop retinopathy and nephropathy [3], and more likely to be hospitalized with diabetes-related. African-Americans with type 2 diabetes report higher levels of diabetes-related distress than non-Hispanic whites [5]. African-Americans have the highest diabetes-related mortality rates of any racial or ethnic group in the United States [3]
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