Effect of diabetes self-management education on glycemic control in Latino adults with type 2 diabetes: A systematic review and meta-analysis

• Published in: Patient education and counseling Vol. 103; no. 2; pp. 266 - 275
• Main Authors: Hildebrand, Janett A., Billimek, John, Lee, Jung-Ah, Sorkin, Dara H., Olshansky, Ellen F., Clancy, Stephen L., Evangelista, Lorraine S.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.02.2020
• Subjects: Adult; Blood Glucose - analysis; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - ethnology; Diabetes Mellitus, Type 2 - psychology; Diabetes Mellitus, Type 2 - therapy; Diabetes self-management education; Disparities; Female; Glycated Hemoglobin A - analysis; Health Behavior; Hispanic Americans; Humans; Latino adults; Male; Meta-analysis; Nursing; Patient Education as Topic - methods; Patient Outcome Assessment; Self Care - methods; Self-Management - education; Type 2 diabetes; Type 2 diabetes; Diabetes self-management education; Disparities; Latino adults; Meta-analysis
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2019.09.009

•Adult Latinos experience more health complications from uncontrolled diabetes.•Culturally tailored DSME programs improve health outcomes in Latinos with T2DM.•On average, Latinos assigned to a DSME program experienced 0.24% A1C reduction.•Heterogeneity in DSME programs requires more studies to identify effective elements.•Generalizations of results to all Latinos is limited due to the various subcultures. This systematic review and meta-analysis evaluated the effectiveness of diabetes self-management education (DSME) in reducing glycosylated hemoglobin (A1C) levels in adult Latinos with type 2 diabetes (T2DM). Five databases were searched for DSME randomized controlled trials or quasi-experimental trials published between January 1997 and March 2019. A random effects model was utilized to calculate combined effect sizes. Subgroup analyses were performed to explore possible sources of heterogeneity between studies. Twenty-three unique studies met criteria for this systematic review and of these, 18 were included in the meta-analysis. Pooled estimate effect of DSME on A1C from the random effect model was -0.240 (95% confidence interval = -0.345, -0.135, p <  0.001). There was moderate heterogeneity (Cochrane Q=30.977, P=0.020, I^2 = 45.121) between the studies. Subgroup analyses demonstrated greater A1C reductions in studies with intervention duration ≤6 months, initial A1C baseline values >8.0 [69 mmol/mol], and team-based approach. Meta-analysis results showed that culturally tailored DSME interventions significantly reduce AIC in Latinos with T2DM despite the heterogeneity across the studies. The heterogeneity in the study methodologies reinforce the need for additional studies to better understand DSME interventions to reduce disparities in Latino adults with T2DM.