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

Abstract

Purpose: 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).

Methods: 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.

Results: 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.

Conclusions: Meta-analysis results showed that culturally tailored DSME interventions significantly reduce AIC in Latinos with T2DM despite the heterogeneity across the studies.

Implications: 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.

Keywords: Diabetes self-management education; Disparities; Latino adults; Meta-analysis; Type 2 diabetes.

Fig. 1.

Flow diagram for study selection Study selection according to PRISMA [22].

Fig. 2.

Risk of bias summary.

Fig. 3.

The forest plot of the mean difference of A1C reduction in study participants. Squares represent effect sizes of individual studies with extended lines denoting 95% confidence interval. Sizes of squares indicate the weight of each study based on the sample size using random effects analysis. The diamond represents the estimated pooled effect size. A ratio of estimates below zero indicates the beneficial treatment effect of DSME.

Fig. 4.

Potential for publication bias. The funnel plot displays the treatment effects of DSME on A1C estimated from the individual studies against the measure of study size.