Comprehensive Diabetes Care Research Articles

Impact of health education on knowledge, attitude, practices and glycemic control in type 2 diabetes mellitus.

Background:Effective health education consequently improves knowledge, attitude, and practices (KAP) leading to better glycemic control and is widely accepted as an integral part of comprehensive diabetes care for affected individuals and their families in primary care settings.Aims:To assess the impact of health education on knowledge, attitude, practices, and glycemic control in type 2 diabetes mellitus patients.Settings and Design:This case control study was conducted in the department of Medicine of a tertiary care teaching hospital.Methods:The study was conducted on 100 diabetic subjects aged more than 40 years comprising of 50 cases and 50 controls. Cases were given education on their disease, drugs, dietary, and lifestyle modifications along with patient education leaflet at baseline and at first follow-up, while controls received neither of these. Subjects were assessed for KAP by administering KAP questionnaire and for glycemic control by measuring glycated hemoglobin (HbA1C) at baseline and at the end of the study.Results:In this study, end mean knowledge, attitude, practice, and KAP SUM scores of cases (10.28 ± 1.78, 3.46 ± 0.93, 3.14 ± 0.86, and 16.82 ± 3.40, respectively) showed significant increase from the baseline (3.86 ± 0.93, 1.00 ± 0.83, 0.40 ± 0.64, and 5.26 ± 2.10, respectively) compared to controls, accompanied by significant reduction in HbA1C of cases at the end of the study compared to the controls.Conclusions:Effective health education improves knowledge, attitude, and practices, particularly with regard to lifestyle modifications and dietary management, culminating into better glycemic control that can slow down the progression of diabetes and prevent downstream complications.

Evaluation of an interprofessional continuing professional development course on comprehensive diabetes care: A mixed-methods approach.

Since there are only 33 endocrinologists within the Department of Defence and over 150000 beneficiaries with diabetes, most patients with diabetes will be treated by primary care providers (PCPs). Comprehensive diabetes care visits are extensive and the clinical practice guidelines (CPGs) routinely change; thus, providing current evidence-based care is difficult. Most professional development courses aim to update PCPs on CPGs but are often inadequate as they focus on only the PCPs (not the interdisciplinary team) without a plan to implement changes into practice. To evaluate the biannual (twice yearly), 3-day, interprofessional Diabetes Champion Course (DCC) developed by the US Air Force Diabetes Center of Excellence on comprehensive diabetes care. A mixed-methods approach was used to evaluate three iterations of the DCC course (Sept 2014-Sept 2015). Quantitatively, pre-course and post-course surveys were used to obtain impact on knowledge, skills, and intention to change clinical practice. Qualitatively, semi-structured phone interviews were conducted with participants to obtain benefits to their clinic related to attending the DCC and barriers to implementation of the CPG process improvement project. Twelve of 19 responding clinics (63%) reported implementing all or part of their original CPG project developed at the DCC, and 17 of 19 clinics (89%) reported improvements associated with attending the DCC. Post-course surveys, from on location participants, revealed significant improvements in knowledge (P<0.01). Likewise, foot exam skills and ability to demonstrate glucose meters to patients improved. Even with high pre-course confidence, 97% of providers reported acquiring new knowledge about prescribing and titrating insulin. The DCC is innovative as it employs a team-based, interprofessional, didactic, and interactive approach that is effective in improving knowledge, skills, and intention to change clinical practice, which should translate to better care for patients with diabetes.

Developing Resident-Sensitive Quality Measures: A Model From Pediatric Emergency Medicine.

To begin closing the gap with respect to quality measures available for use among residents, the authors sought to identify and develop resident-sensitive quality measures (RSQMs) for use in the pediatric emergency department (PED) setting. In May 2016, the authors reviewed National Quality Measures Clearinghouse (NQMC) measures to identify resident-sensitive measures. To create additional measures focused on common, acute illnesses (acute asthma exacerbation, bronchiolitis, closed head injury [CHI]) in the PED, the authors used a nominal group technique (NGT) and Delphi process from September to December 2016. To achieve a local focus for developing these measures, all NGT and Delphi participants were from Cincinnati Children's Hospital Medical Center. Delphi participants rated measures developed through the NGT in two areas: importance of measure to quality care and likelihood that measure represents the work of a resident. The review of NQMC measures identified 28 of 183 as being potentially resident sensitive. The NGT produced 67 measures for asthma, 46 for bronchiolitis, and 48 for CHI. These were used in the first round of the Delphi process. After two rounds, 18 measures for asthma, 21 for bronchiolitis, and 21 for CHI met automatic inclusion criteria. In round three, participants categorized the potential final measures by their top 10 and next 5. This study describes a template for identifying and developing RSQMs that may promote high-quality care delivery during and following training. Next steps should include implementing and seeking validity evidence for the locally developed measures.

Improving the Recognition and Management of Elevated Blood Pressure among Youth with Type 1 Diabetes

Background: Studies show that youth with type 1 diabetes (T1D) harbor cardiovascular risk factors and exhibit clinical signs suggestive of cardiovascular disease. ADA and ISPAD guidelines promote regular blood pressure screening to reduce cardiovascular risk, and strategies should involve effective screening and management. The diabetes clinic previously had limited measures in place to manage T1D youth with elevated blood pressure. Objective: The aim of this quality improvement (QI) project was to increase provider recognition and follow-up of TID patients with elevated blood pressure readings ≥ 95%tile for age/gender/height, from 0% to 50%, by 12/31/17 and sustain through 12/31/2018. Methods: After the QI team clarified project goals, a Key Driver Diagram (KDD) and elevated blood pressure process map was established. This algorithm aided to clarify the care process to efficiently recognize and manage youth with T1D who presented with elevated blood pressure in the outpatient diabetes clinic. A “Best Practice Alert” (BPA) was created within the electronic medical record, which alerted the diabetes care team of the presence of elevated blood pressure among T1D patients in clinic. This allowed the provider to choose electronically tracked care options in the medical record to manage elevated blood pressure among T1D patients and coordinate care among subspecialties that manage elevated blood pressure. Data reports were compiled to track utilization of the blood pressure BPA from May 2017 (initiation date) to December 2017 with ongoing data collection. Results: Upon BPA creation, process mean of the utilization and management of elevated blood pressure BPA among T1D youth increased to 73% over a 7 month period. Conclusions: This project successfully improved screening and management of T1D youth with elevated blood pressure in the outpatient setting. This project builds on comprehensive diabetes care, with the hope of reducing future cardiovascular burden for youth with T1D. Disclosure K. Gandhi: None. D.A. Buckingham: None. J. Hehmeyer: None. A.M. Kramer: None. K. Obrynba: None. J.A. Indyk: None. M.K. Kamboj: None.

Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Diabetes Care

There are 30.3 million people with diabetes and 86 million with prediabetes in the United States, underscoring the growing need for comprehensive diabetes care and nutrition for the management of diabetes and diabetes-related conditions. Management of diabetes is also critical for the prevention of diabetes-related complications such as cardiovascular and renal disease. The Diabetes Care and Education Dietetic Practice Group along with the Academy of Nutrition and Dietetics Quality Management Committee have updated the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitian Nutritionists (RDNs) in Diabetes Care. The SOP and SOPP for RDNs in Diabetes Care provide indicators that describe three levels of practice: competent, proficient, and expert. The SOP utilizes the Nutrition Care Process and clinical workflow elements for care and management of those with diabetes and prediabetes. The SOPP describes six domains that focus on professionalism: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Specific indicators outlined in the SOP and SOPP depict how these standards apply to practice. The SOP and SOPP are complementary resources for RDNs caring for individuals with diabetes or specializing in diabetes care or practicing in other diabetes-related areas, including research. The SOP and SOPP are intended to be used for RDN self-evaluation for ensuring competent practice and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.

Efficacy of Comprehensive Diabetes Care (CDC) Management Program in Elderly Male Patients of Type II Diabetes Mellitus: A Retrospective Study

Globally, Diabetes mellitus (DM) prevalence has created menace, being a major culprit of increased mortality and morbidity and health care expenditures. India is the 2nd country with maximum number of diabetic patients, with an estimated prevalence of around 10%. Comprehensive Diabetes Care (CDC) is a combination of Panchakarma and Diet management. This study was conducted to evaluate the effect of CDC on glycosylated haemoglobin (HbA1c), body mass index (BMI), body weight, abdominal girth and dependency on conventional therapy in DM Patients. This retrospective study was conducted from July 2017 to January 2018, wherein the data of elderly male type 2 DM patients (HbA1c >6.5%) who attended Madhavbaug clinics in Maharashtra, India were identified. Data of patients who were administered CDC (60-75 minutes) with minimum 6 sittings over 90 days (± 15 days) were considered. Variables were compared between day 1 and day 90 of CDC. Out of 48 enrolled elderly male patients, 34 were included for analysis. CDC showed significant improvement in HbA1c from 8.27 ± 0.96to 7.1 ± 1.30; p=0.0001), BMI from 27.65 ± 3.20 to 25.91 ± 3.29, p< 0.0001), weight from 73.75 ± 10.76to 69.46 ± 10.39, p<0.0001). Abdominal girth (from 100.0 ± 9.08 to 95.36 ± 9.10; p<0.0001), also showed significant reduction. Dependency on concomitant medicines was reduced, with number of patients on no concomitant medicines increasing from 3% to 15%. CDC and allopathy both are found to be efficacious; but CDC acts dually, by reducing HbA1c, as well as reducing dependency on allopathic medications.

Food Insecurity and Depression Among Adults With Diabetes: Results From the National Health and Nutrition Examination Survey (NHANES).

Purpose While both food insecurity and depression have been linked to risk of type 2 diabetes, little is known about the relationship between food insecurity and depression among adults with diabetes. Research Design and Methods Cross-sectional analyses of the National Health and Nutrition Examination Survey (2011-2014), a nationally representative, population-based survey. Analytic sample was limited to adults aged ≥20 with diabetes determined by either fasting plasma glucose (≥126 mg/dL) or self-report (n = 1724) and adults age ≥20 with prediabetes determined by fasting plasma glucose (100-125 mg/dL) or self-report (n = 2004). Food insecurity was measured using the US Food Security Survey Module. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression was used to assess the relationship between food insecurity and depression while accounting for sociodemographic characteristics and health behaviors. Results Approximately 10% of individuals with diabetes and 8.5% of individuals with prediabetes had severe food insecurity in the past year; an additional 20.3% of individuals with diabetes and 14.3% of those with prediabetes had mild food insecurity. Among individuals with diabetes, both mild and severe food insecurity were associated with elevated odds of depression These relationships were similar in magnitude among individuals with prediabetes. Conclusions Food insecurity is significantly associated with depressive symptoms in people with diabetes and prediabetes. Results point to the need to address economic issues in conjunction with psychosocial issues for comprehensive diabetes care.

Abstract #1103: Comprehensive Diabetes Care Through Continuous Communication Channels to Patients with Diabetes

Abstract #1103: Comprehensive Diabetes Care Through Continuous Communication Channels to Patients with Diabetes

Second ASPED/ISPAD Diabetes postgraduate course; 12th-14th May, 2016, Abu Dhabi, United Arab Emirates

The second ASPED/ISPAD Diabetes postgraduate course is an intensive course initiated by the Arab Society of Paediatric Endocrinology and Diabetes (ASPED) in collaboration with the International Society of Pediatric and Adolescence Diabetes (ISPAD). The course is exclusively sponsored by Lilly, Gulf. The course was held in Abu Dhabi over 3 days. It was run by an expert group of faculty from 12 different countries. The faculty group consisted of 4 speakers from ISPAD, 13 speakers and mentors from ASPED. Candidates were selected following open competitive applications which was advertised by both ASPED and ISPAD. Strict enrolment criteria were agreed on by the ASPED/ISPAD course committee. 64 candidates (out of 142 applicants) from 12 countries were enrolled and attended the course. Course curriculum was delivered in the form of lectures, interactive sessions, case scenarios and research presentation in small group sessions. The themes of the curriculum featured; comprehensive diabetes care, diabetes registry (international and regional experience), dietary challenges, monogenic diabetes (international and regional experience), diabetes management in special circumstances (school, sick days and Ramadan fasting), diabetes complications; acute and chronic, psychology and patient empowerment, obesity and type 2 diabetes in children, novel therapeutic approaches and diabetes prevention and use of technology in diabetes management. The course ended with tasks to follow and recommendations. A task force of 7 members from 6 countries was nominated to initiate and follow up on the execution of the tasks. The main task was to start building up an ASPED diabetes registry amongst different Arab countries. Plans regarding curriculum, venue and course format for future annual courses will be implemented based on faculty and attendees feedback reports.

Access to Diabetes Care for Populations Experiencing Homelessness: an Integrated Review.

Populations experiencing homelessness with diabetes may encounter barriers to accessing comprehensive diabetes care to manage the condition, yet it is unclear to what extent this population is able to access care. We reviewed the literature to identify and describe the barriers and facilitators to accessing diabetes care and managing diabetes for homeless populations using the Equity of Access to Medical Care Framework. An integrated review of the literature was conducted and yielded 10 articles that met inclusion criteria. Integrated reviews search, summarize, and critique the state of the research evidence. Findings were organized using the dimensions of a comprehensive conceptual framework, the Equity of Access to Medical Care Framework, to identify barriers and facilitators to accessing care and managing diabetes. Barriers included competing priorities, limited access to healthy food, and inadequate healthcare resources. Facilitators to care included integrated delivery systems that provided both social and health-related services, and increased patient knowledge. Recommendations are provided for healthcare providers and public health practitioners to optimize diabetes outcomes for this population.

Sustaining Effect of Intensive Nutritional Intervention Combined with Health Education on Dietary Behavior and Plasma Glucose in Type 2 Diabetes Mellitus Patients.

Diabetes mellitus is very common in elderly Chinese individuals. Although nutritional intervention can provide a balanced diet, the sustaining effect on at-home dietary behavior and long-term plasma glucose control is not clear. Consequently, we conducted a long-term survey following one month of experiential nutritional intervention combined with health education. Based on the Dietary Guidelines for a Chinese Resident, we found that the food items met the recommended values, the percentages of energy provided from fat, protein, and carbohydrate were more reasonable after one year. The newly formed dietary patterns were “Healthy”, “Monotonous”, “Vegetarian”, “Japanese”, “Low energy”, and “Traditional” diets. The 2h-PG of female participants as well as those favoring the “Japanese diet” decreased above 12 mmol/L. Participants who selected “Japanese” and “Healthy” diets showed an obvious reduction in FPG while the FPG of participants from Group A declined slightly. “Japanese” and “Healthy” diets also obtained the highest DDP scores, and thus can be considered suitable for T2DM treatment in China. The results of the newly formed dietary patterns, “Japanese” and “Healthy” diets, confirmed the profound efficacy of nutritional intervention combined with health education for improving dietary behavior and glycemic control although health education played a more important role. The present study is encouraging with regard to further exploration of comprehensive diabetes care.

Comparison of use of diabetic medication and clinical guidelines in four Nordic countries

Background Clinical guidelines form one of the cornerstones for providing high-quality care for patients with diabetes. We compare the national guidelines and the use of glucose lowering medication for type 2 diabetes (T2D) in Denmark, Finland, Norway and Sweden.Methods We compared how guidelines take comprehensive care into consideration, what treatment targets and what antihyperglycemic medication was recommended. The use of glucose-lowering medication was based on the sales of diabetes drugs in these countries.Results All guidelines stress the importance of comprehensive diabetes care. Individualized glycemic targets are emphasized especially in the Danish and Finnish guidelines. In 2013, sulfonylureas were the most common second-line treatment after metformin in Denmark, Norway and Sweden; in Finland, this position was taken by DPP-4 inhibitors. Recommended initial insulin type for patients with T2D differs between the four countries. Danish, Norwegian and Swedish guidelines also take economic aspects into account.Conclusions All guidelines stress regular and comprehensive diabetes care. Danish and Finnish guidelines strongly underline the importance of individualized glycemic targets. All guidelines recommend metformin as the initial oral antihyperglycemic drug. In relation to recommended second line drug therapy and initial insulin type for patients with T2D, the guidelines vary largely between the four countries. Key messagesAll Nordic guidelines for treating type 2 diabetes stress the importance of comprehensive care.The Danish and Finnish guidelines underline the importance of individualized glycemic targets.The first line and most commonly used oral antihyperglycemic drug is metformin in all four countries.Recommended second line antihyperglycemic treatment differs largely between the four Nordic guidelines.Recommended initial insulin type for patients with T2D differs between the guidelines.

Developments in Diabetology in 2016

Two major trials, LEADER and SUSTAIN 6, published in 2016, reported the cardiovascular and microvascular benefits of liraglutide and semaglutide respectively. This communication describes the results of these trials, and analyses the subtle differences in their outcomes. While semaglutide significantly reduces the risk of non-fatal myocardial infarction (primary prevention), liraglutide reduces the risk of all-cause mortality and cardiovascular mortality (secondary prevention). Both drugs significantly improve renal outcomes, but semaglutide increased the risk of retinal events. The time taken to achieve benefit was much less (4-6 months) with semaglutide than with liraglutide (12–18 months). LEADER and SUSTAIN 6 have made 2016 a landmark year in the history of diabetes care. Their positive results will help promote better, comprehensive diabetes care, using minimal drugs (therapeutic parsimony), encourage use of rational combinations to improve outcomes, and stimulate exaptation of these drugs for non-glycemic purposes.

Impact of a 10 minute Seated Yoga Practice in the Management of Diabetes.

We sought to prospectively evaluate the impact of a 10 minute seated yoga program added to standard comprehensive diabetes care on glucose control and cardiovascular health in the severely ill, medically complex diabetic population. A total of 10 patients with type 2 diabetes, ages 49-77, with duration of diabetes >10 years and haemoglobin A1C >9% (75 mmol/mol) were included in the study. Patients randomized to a yoga intervention were taught a 10 minute seated yoga practice, were given an explanatory DVD and a fold-out pocket guide to encourage adherence at home, and were instructed to incorporate the practice as often as they could. The patients in the control arm were provided information and hand outs on the available yoga classes on campus. At 3 month clinical follow up, the mean decrease in fasting capillary blood glucose (CBG) was 45% among yoga participants (-5.2 ± 4.1 mmol/L). Heart rate (HR) dropped by 18% and Diastolic blood pressure (BP) dropped by 29% in the intervention arm, (-12.4 ± 6.69 and -26 ± 12.05 mmHg, respectively). There were no statistically significant changes in the haemoglobin A1C, systolic blood pressure, weight, or body mass index in either group. Our small pilot study reinforces the current medical evidence supporting the use of yoga, combined with standard care, to improve health outcomes in diabetes.

Social and Environmental Barriers to Nutrition Therapy for Diabetes Management Among Underserved Pregnant Women: A Qualitative Analysis

ObjectiveTo identify social and environmental barriers to nutrition therapy for diabetes management during pregnancy among a population of low-income, minority pregnant women. DesignProspective, in-depth, semi-structured interviews performed serially during pregnancy and continued until thematic saturation was reached. SettingUrban academic medical center. ParticipantsTen pregnant low-income, minority women with gestational diabetes and type 2 diabetes mellitus. Phenomenon of InterestSocial and environmental barriers to nutrition therapy for diabetes management during pregnancy. AnalysisQualitative analysis of interview data using electronic coding software was performed using theme analysis. ResultsParticipants perceived limited ability and self-efficacy to adopt nutrition recommendations. Specific themes identified as barriers included (1) feeling overwhelmed by the unfamiliar; (2) using and decoding nutrition labels; (3) managing nutrition choices and seeking control in the setting of food insecurity; (4) experiencing lack of control and motivation, and limited self-efficacy; (5) balancing recommendations with taste preferences and cultural food norms; (6) maintaining a healthy eating schedule; and (7) accommodating diabetes in family and social life. Conclusions and ImplicationsPregnant women with diabetes encounter a number of knowledge-based, attitudinal, and resource-related barriers that reduce capacity for nutrition therapy adherence. Provision of culturally informed, practical nutrition support that addresses the needs of women in low-resource communities is an important component of comprehensive diabetes care during pregnancy.

What Peer Mentoring Adds to Already Good Patient Care: Implementing the Carpeta Roja Peer Mentoring Program in a Well-Resourced Health Care System.

The purpose of this study was to evaluate the impact of a peer support program on the health outcomes of patients already receiving well-organized, comprehensive diabetes care. We used a mixed-methods, nonrandomized, control-group design to evaluate the impact of a peer-mentoring program on the health outcomes and self-management behaviors of adults with type 2 diabetes in 15 primary care practices in San Antonio. Propensity score analysis, t-tests, and multivariable repeated analyses were used to evaluate impact. Qualitative interviews were conducted with 15 participants in the intervention group and analyzed using a grounded theory approach. Both intervention and control groups showed significant improvement on all health indicators from baseline to 6-month follow-up (P<.001). Hemoglobin A1c (HbA1c) decreased slightly faster for patients in the intervention group (P=.04). Self-management behaviors improved significantly from baseline to 6-month follow-up for the intervention group. Interviewed participants also reported reductions in social isolation and extension of impact of health behavior changes to multiple generations of family members. The addition of peer mentoring to already well-organized comprehensive diabetes care does not improve outcomes. However, findings suggest that the impact of the program extends to members of the participants' families, which is an intriguing finding that deserves further study.

Anxiety in children and adolescents with type 1 diabetes.

Although anxiety is a normal and developmentally appropriate experience of childhood and anxiety disorders are among the most commonly diagnosed disorders, the prevalence of anxiety symptomatology and anxiety disorders in children with type 1 diabetes (T1D) is not well documented. Most studies have focused on anxiety-related syndromes associated with T1D including fear of hypoglycemia, specific phobia of needles (i.e., needle anxiety), and anxiety related to uptake of new and sophisticated diabetes technology (e.g., continuous glucose monitors, continuous subcutaneous infusion therapy), but the extant literature is sparse, and more research is greatly needed. Identification, prevention, and treatment of anxiety are critical to providing comprehensive diabetes care and management. This review provides a summary of the literature focused on anxiety in children and adolescents with T1D with suggestions for future research and clinical implications.

Diabetes quality of care at a university community in Beirut.

To assess the quality of diabetes mellitus (DM) care provided by a group of family doctors in Beirut. An observational study, conducted at the American University of Beirut Medical Center-Family Medicine Clinics (AUBMC-FMC), examined the electronic health records (EHRs) of the beneficiaries of the Health Insurance Plan at the American University of Beirut (AUB-HIP) who were older than 20 years (n = 9469) in 2009. The eligible population included patients with DM (n = 701). Several provider/patient-directed interventions were introduced in the late 2000s, including a comprehensive EHRs system with point-of-care computer reminders, a provider financial incentive based on an annual performance appraisal ranked against that of the US Healthcare Effectiveness Data and Information Set (HEDIS) Comprehensive Diabetes Care indicators, as well as periodic up-to-date training. Optimal control for HbA1c, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides and blood pressure were found in 58.6%, 51.0%, 22.4%, 53.3% and 60.2% of the population, respectively. 64.1% and 70.0% received screening for diabetic nephropathy and a dilated eye examination, respectively. When benchmarked against the HEDIS Comprehensive Diabetes Care indicators, the AUB-HIP's quality of care was 13% higher than the average of all plans in the United States. Screening for nephropathy, however, did not reach the above benchmark. Benchmarking served as an important tool in evaluating the current DM care offered and in detecting gaps, yet interventions are recommended for further improvement.

Abstract #282: Efficacy and Safety of new Insulin Glargine 300 u/ml in Basal Insulintreated Patients with Type 2 Diabetes Mellitus using Selected Comprehensive Diabetes care Hedis Measures

Abstract #282: Efficacy and Safety of new Insulin Glargine 300 u/ml in Basal Insulintreated Patients with Type 2 Diabetes Mellitus using Selected Comprehensive Diabetes care Hedis Measures

Limited evidence to assess the impact of primary health care system or service level attributes on health outcomes of Indigenous people with type 2 diabetes: a systematic review.

BackgroundTo describe reported studies of the impact on HbA1C levels, diabetes-related hospitalisations, and other primary care health endpoints of initiatives aimed at improving the management of diabetes in Indigenous adult populations of Australia, Canada, New Zealand and the United States.MethodSystematic literature review using data sources of MEDLINE, Embase, the Cochrane Library, CINHAL and PsycInfo from January 1985 to March 2012. Inclusion criteria were a clearly described primary care intervention, model of care or service, delivered to Indigenous adults with type 2 diabetes reporting a program impact on at least one quantitative diabetes-related health outcome, and where results were reported separately for Indigenous persons. Joanna Briggs Institute critical appraisal tools were used to assess the study quality. PRISMA guidelines were used for reporting.ResultsThe search strategy retrieved 2714 articles. Of these, 13 studies met the review inclusion criteria. Three levels of primary care initiatives were identified: 1) addition of a single service component to the existing service, 2) system-level improvement processes to enhance the quality of diabetes care, 3) change in primary health funding to support better access to care. Initiatives included in the review were diverse and included comprehensive multi-disciplinary diabetes care, specific workforce development, systematic foot care and intensive individual hypertension management. Twelve studies reported HbA1C, of those one also reported hospitalisations and one reported the incidence of lower limb amputation. The methodological quality of the four comparable cohort and seven observational studies was good, and moderate for the two randomised control trials.ConclusionsThe current literature provides an inadequate evidence base for making important policy and practice decisions in relation to primary care initiatives for Indigenous persons with type 2 diabetes. This reflects a very small number of published studies, the general reliance on intermediate health outcomes and the predominance of observational studies. Additional studies of the impacts of primary care need to consider carefully research design and the reporting of hospital outcomes or other primary end points. This is an important question for policy makers and further high quality research is needed to contribute to an evidence-base to inform decision making.