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

•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 iden...

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Published inPatient 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
LanguageEnglish
Published Ireland Elsevier B.V 01.02.2020
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Abstract •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.
AbstractList PURPOSEThis 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). METHODSFive 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. RESULTSTwenty-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. CONCLUSIONSMeta-analysis results showed that culturally tailored DSME interventions significantly reduce AIC in Latinos with T2DM despite the heterogeneity across the studies. IMPLICATIONSThe heterogeneity in the study methodologies reinforce the need for additional studies to better understand DSME interventions to reduce disparities in Latino adults with T2DM.
•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.
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.
Author Sorkin, Dara H.
Olshansky, Ellen F.
Hildebrand, Janett A.
Billimek, John
Lee, Jung-Ah
Evangelista, Lorraine S.
Clancy, Stephen L.
AuthorAffiliation f University of Texas Medical Branch School of Nursing
e UCI Science Library, University of California, Irvine, USA
a University of Southern California, Suzanne Dworak-Peck School of Social Work, Department of Nursing
b Program in Medical Education for the Latino Community, Health Policy Research Institute, Departments of Medicine and Family Medicine, University of California, Irvine, USA
d Department of Medicine, University of California, Irvine, USA
c Sue and Bill Gross School of Nursing, University of California, Irvine, USA
AuthorAffiliation_xml – name: e UCI Science Library, University of California, Irvine, USA
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  surname: Evangelista
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Issue 2
Keywords Type 2 diabetes
Diabetes self-management education
Disparities
Latino adults
Meta-analysis
Language English
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Authors contribution
S.L. and J.H. completed the literature search. J.H. wrote the manuscript and researched the data. E.L. researched the data and reviewed/edited the manuscript. S.D. reviewed data and contributed to the discussion and reviewed/edited the manuscript. J.B. reviewed the data, contributed to the analysis of the data and discussion and reviewed/edited the manuscript. J.L. and E.O. reviewed/edited the manuscript.
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Snippet •Adult Latinos experience more health complications from uncontrolled diabetes.•Culturally tailored DSME programs improve health outcomes in Latinos with...
This systematic review and meta-analysis evaluated the effectiveness of diabetes self-management education (DSME) in reducing glycosylated hemoglobin (A1C)...
PURPOSEThis systematic review and meta-analysis evaluated the effectiveness of diabetes self-management education (DSME) in reducing glycosylated hemoglobin...
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StartPage 266
SubjectTerms 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
Title Effect of diabetes self-management education on glycemic control in Latino adults with type 2 diabetes: A systematic review and meta-analysis
URI https://dx.doi.org/10.1016/j.pec.2019.09.009
https://www.ncbi.nlm.nih.gov/pubmed/31542186
https://search.proquest.com/docview/2296140833
https://pubmed.ncbi.nlm.nih.gov/PMC8087170
Volume 103
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