Community-based educational interventions for prevention of type II diabetes: a global systematic review and meta-analysis

Abstract

Purpose Our objective was to estimate the change in community-based education interventions throughout the world that may effectuate in risk parameters of type II diabetes (T2D), including the diabetes incidence rate, fasting blood glucose, hemoglobin A1C, body mass index, waist circumference, and systolic and diastolic blood pressure. Methods A comprehensive search for globally eligible studies was conducted on PubMed, Embase, ProQuest, CINAHL nursing & allied health source, Cochrane Library, Google Scholar, conference proceedings, and reference lists. Data were extracted using JBI standardized data extraction tool. The primary outcome variables were diabetes incidence rate, fasting blood sugar (FBS), hemoglobin A1c (HbAlc), body mass index (BMI), waist circumference (WC), systolic/diastolic blood pressure (s/d BP). Random-effects meta-analysis and sub-group analyses were conducted. Results Nineteen interventional studies were included in the review, and ten studies were pooled in the meta-analysis (n = 16,106, mean age = 41.5 years). The incidence rate of T2D was reported in three trials, within which the risk of developing T2D was reduced by 54.0% in favor of community-based educational interventions, (RR = 0.54, 95% CI = 0.38–0.75; p < 0.001). In eleven (n = 11,587) and six (n = 6416) studies, the pooled mean differences were − 0.33 (95% CI: − 0.45 to − 0.20, p < 0.0001) and − 0.15 (95% CI: − 0.28 to − 0.03, p < 0.0001) for FBS and HbA1c levels, respectively. Positive significant effects were observed on reducing BMI [pooled mean difference = − 0.47 (95% CI: − 0.66 to − 0.28), I2 = 95.7%, p < 0.0001] and WC [pooled mean difference = − 0.66 (95% CI: − 0.89 to − 0.43), I2 = 97.3%, p < 0.0001]. The use of theoretical frameworks was found to provide a 48.0% change in fasting blood sugar. Conclusions Based on a comprehensive data collection of about 16,106 participants and reasonable analyses, we conclude that educational interventions may reduce diabetes incidence by 54.0%, particularly through reductions in fasting blood glucose, body mass index, and waist circumference. The diabetes risk parameters may favorably improve irrespective of the duration of intervention, at as low as 6 months. The application of theoretical frameworks while designing educational interventions is also encouraged. Systematic review registration PROSPERO CRD42018115877

The effectiveness of diabetes self-management education intervention on glycaemic control and cardiometabolic risk in adults with type 2 diabetes in low- and middle-income countries: A systematic review and meta-analysis

“…The findings are in line with those of the previous review that showed the positive effects of group-based self-management education interventions on HbA1c, FBG, body weight, WC, TG and diabetes knowledge [98]. Another review, however, showed that there was no effect of community-based educational interventions on SBP and DBP [99]. Overall, these findings support the potential clinical, behavioural and psychological efficacy of DSME intervention in patients with T2DM.…”

“…Second, the majority of the studies reported outcomes from less than one year follow-up, therefore the long-term effectiveness of DSME intervention in the management of T2DM population cannot be demonstrated. Third, high heterogeneity was observed in the meta-analyses for most of the outcome measures, which is likely due to variation in intervention programme design across the studies [99] as typically noted in intervention programmes of this nature. Fourth, no trial was categorised as low risk in all five components of the ROB 2 assessment tool.…”

Community-based nursing: a concept analysis with Walker and Avant’s approach

“…The philosophy of community-based nursing is to guide nursing care for individuals, families with health problems, and other groups throughout life, wherever they are, including where they live, work and go to school, etc. According to this definition, community-based nursing is not a specialty but a philosophy that guides all nursing care [3] and have been mentioned in different studies [3,54].…”

Empoderamiento como estrategia para el autocuidado en las personas con diabetes tipo 2: una revisión sistemática

“…Estas intervenciones proporcionaron un buen efecto sobre el control glucémico en comparación con las individuales; en particular, los programas realizados durante 12 meses en el contexto comunitario con 3 o más meses de seguimiento tuvieron mayor significancia. Según Shirvani et al 45 , las intervenciones educativas pueden reducir la incidencia de complicaciones de la DT2 por arriba de un 50%, en especial en cuanto a reducciones en la glucemia en ayunas, el IMC y la circunferencia de la cintura.…”