Health system responses for type 1 diabetes: A scoping review

Abstract

Aims The focus of health system interventions for noncommunicable diseases and diabetes focus mainly on primary health care responses. However, existing interventions are not necessarily adapted for the complex management of type 1 diabetes (T1DM). We aimed to identify and describe health system interventions which have been developed to improve the management of T1DM globally. Methods We conducted a scoping review by searching MEDLINE, Embase, and Global Health using OVID for peer‐review articles published in either English, Spanish, Portuguese or French in the last 10 years. We classified the intervention strategies according to the Effective Practice and Organization of Care (EPOC) taxonomy for health system interventions and the World Health Organization (WHO) health system building blocks. Results This review identified 159 health system interventions to improve T1DM management. Over half of the studies focused only on children or adolescents with type 1 diabetes. Only a small fraction of the studies were conducted in low‐and‐middle income countries (LMICs). According to the EPOC taxonomy, the most frequently studied category was delivery arrangement interventions, while implementation strategies and financial arrangements were less frequently studied. Also, governance arrangements domains were not studied. The most common combination of intervention strategies included self‐management with either telemedicine, use of information and smart home technologies. Conclusions There is a need to expand potential interventions to other EPOC strategies to assess their potential effect on health outcomes in people with T1DM, as well as to involve more LMIC settings as the impact may be greater in these settings.

Outcomes measured in studies assessing health systems interventions for type 1 diabetes management: A scoping review

“…This scoping review used information collected as part of a previous study. 3 This information was enriched by extracting new details about the outcomes used and by updating the search. The protocol is available on the YARETA repository.…”

“…The original study found a total of 159 studies (171 reports). 3 The updated search found 28 new studies (30 reports), totaling 187 studies included. Figure 1 presents the flowchart of the yield of the update search conducted in January 2022.…”

“…A previous review on health system interventions found that studies mainly focused on delivery of care and failed to assess other types of interventions such as financial arrangements, legal or policy interventions or implementation strategies. 3 These contextual factors contribute to poorer care, which can lead to micro-and macrovascular complications, in addition to the psychosocial impact on the individual and their family. 4,5 To tackle these challenges related to type 1 diabetes globally in 2021 the World Health Assembly adopted a Resolution emphasizing the need to access healthcare services and quality of care for diabetes, 6 as well as the World Health Organization (WHO) launching a Global Diabetes Compact.…”

“…8 A scoping review of health system interventions for type 1 diabetes management found that most of the existing interventions focused on delivery of care with great emphasis on selfmanagement and information and communication technologies. 3 To understand the effect of these interventions, studies that evaluate outcomes, "the patient-relevant consequences" 9 of an intervention, are needed. The information collected in these studies could then inform policy and practice to improve services provided to people living with type 1 diabetes.…”

“…Some reasons are the challenges in accessing healthcare and that existing health systems interventions are not necessarily adapted for the complex management of type 1 diabetes. A previous review on health system interventions found that studies mainly focused on delivery of care and failed to assess other types of interventions such as financial arrangements, legal or policy interventions or implementation strategies 3 . These contextual factors contribute to poorer care, which can lead to micro‐ and macrovascular complications, in addition to the psychosocial impact on the individual and their family 4,5 .…”