Lifestyle interventions for type 2 diabetes management among migrants and ethnic minorities living in industrialized countries: a systematic review and meta-analyses

Abstract

The objective of this systematic review was to determine the effectiveness of lifestyle interventions to improve the management of type 2 diabetes mellitus (T2DM) among migrants and ethnic minorities. Major searched databases included MEDLINE (via PubMed), EMBASE (via Ovid) and CINAHL. The selection of studies and data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the meta-analysis, significant heterogeneity was detected among the studies (I2 >50%), and hence a random effects model was used. Subgroup analyses were performed to compare the effect of lifestyle interventions according to intervention approaches (peer-led vs community health workers (CHWs)-led). A total of 17 studies were included in this review which used interventions delivered by CHWs or peer supporters or combination of both. The majority of the studies assessed effectiveness of key primary (hemoglobin (HbA1c), lipids, fasting plasma glucose) and secondary outcomes (weight, body mass index, blood pressure, physical activity, alcohol consumption, tobacco smoking, food habits and healthcare utilization). Meta-analyses showed lifestyle interventions were associated with a small but statistically significant reduction in HbA1c level (−0.18%; 95% CI −0.32% to −0.04%, p=0.031). In subgroup analyses, the peer-led interventions showed relatively better HbA1c improvement than CHW-led interventions, but the difference was not statistically significant (p=0.379). Seven studies presented intervention costs, which ranged from US$131 to US$461 per participant per year. We conclude that lifestyle interventions using either CHWs or peer supporters or a combination of both have shown modest effectiveness for T2DM management among migrants of different background and origin and ethnic minorities. The evidence base is promising in terms of developing culturally appropriate, clinically sound and cost-effective intervention approaches to respond to the growing and diverse migrants and ethnic minorities affected by diabetes worldwide.

The effect of peer support in diabetes self-management education on glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis

“…The analysis according to the type of intervention delivery revealed that group interventions had a statistically significant effect on HbA1c levels (SMD, -0.28; p=0.010), and this effect was higher than interventions with other types of delivery. This result aligns with a previous meta-analysis showing that group interventions were better at optimizing outcomes for diabetes [ 44 , 46 ].…”

Engaging Ethnically Diverse Populations in Self-Management Interventions for Chronic Respiratory Diseases: A Narrative Review

“…Commitment refers to the cognitive and emotional factors that empower people to use the health resources that are available to them [ 35 , 48 ]. Commitment needs to be demonstrated by the user over time, and may be stimulated through social support and intellectual resources to encourage behavior changes toward improving the individual’s health status [ 35 ].…”

“…Commitment needs to be demonstrated by the user over time, and may be stimulated through social support and intellectual resources to encourage behavior changes toward improving the individual’s health status [ 35 ]. An example of commitment in chronic disease management is the use of health coaching for people with diabetes, where the health professional plays the role of a coach to facilitate the individual in developing strategies to manage their chronic illness rather than telling the individual what to do [ 48 ].…”

Diabetes and Migration

“…Indeed, lifestyle interventions among migrant groups and ethnic minorities appear to be only moderately effective in lowering the HbA1c value [57]. A recent systematic review with meta-analysis also finds that lifestyle interventions with peer support have positive effects on clini cal outcomes such as the HbA1c value, as well as on the knowledge and practices of diabetes self-management [59].…”