We used the EPOC review group’s definition of health system interventions as those designed to “improve the professional practice and the delivery of effective health services” through changes in healthcare delivery, financing, governance, and implementation [5,14]. Practical telehealth to improve control and engagement for patients with clinic-refractory diabetes mellitus (PRACTICE-DM): Protocol and baseline data for a randomized trial. Type 2 diabetes disproportionately affects people in low- and middle-income countries (LMICs). Difference in change-from-baseline HbA 1c…, Figure A2:. An advantage of including only RCTs is that we are able to offer robust evidence of the impact of health system interventions on glycemic control and reveal the limited data on other outcomes. No, Is the Subject Area "Type 2 diabetes risk" applicable to this article? Visualization, Interventions focusing solely on implementing diabetes education or support within the health system also were effective in improving glycemic control, but the certainty of evidence was low. Supervision, Diabetes is a serious chronic condition affecting millions of people worldwide and is the sixth leading cause of death in Canada. EPOC, However, health system interventions designed and tested in HICs may not be generalizable to LMICs . Importantly, we included diabetes education or support trials that primarily changed the behavior of health workers within the health system, and we excluded lifestyle trials focusing on patient behavior alone without systems-level change. When multiple reports were identified, we linked the reports together for extraction and analysis. See this image and copyright information in PMC. We excluded non-randomized study designs given the challenge in attributing causality for outcomes and inconsistent reporting of these designs in pilot searches. short message service. Department of Global Health, University of Washington, Seattle, Washington, United States of America, Data curation, Difference in change-from-baseline HbA 1c values between behavioural interventions and usual care control…, Figure A9:. Psychological interventions for Type 2 diabetes control: A1c, blood glucose, weight, BMI, & psychological distress. Data from the United Kingdom Prospective Diabetes Study (UKPDS) has shown that tight glycemic control can significantly reduce the risk of developing serious complications in type 2 diabetics. Our review was restricted to studies with at least 6 months of follow-up and 100 enrolled participants. Patients were recruited from several settings: six studies from primary or general medical practices, three studies from the community (e.g. Center for Research in Indigenous Health, Wuqu’ Kawoq, Tecpán, Guatemala, Epub 2020 Sep 21. Moreover, heterogeneity in the interventions has led to conflicting evidence on the components of effective programs. Endocrine Today reports on five interventions that reduced mortality, comorbid illness, symptoms and critical outcomes in adult patients being treated for type 2 diabetes. Obesity, nutrition, and physical activity programs in the workplace are critical elements in addressing type 2 diabetes Research suggests that the progression from prediabetes to type 2 diabetes can be prevented or delayed. https://doi.org/10.1371/journal.pmed.1003434, Academic Editor: Andre P. Kengne, South African Medical Research Council, SOUTH AFRICA, Received: April 28, 2020; Accepted: October 19, 2020; Published: November 12, 2020. https://doi.org/10.1371/journal.pmed.1003434.s001, https://doi.org/10.1371/journal.pmed.1003434.s002, https://doi.org/10.1371/journal.pmed.1003434.s003, https://doi.org/10.1371/journal.pmed.1003434.s004, https://doi.org/10.1371/journal.pmed.1003434.s005, https://doi.org/10.1371/journal.pmed.1003434.s006, https://doi.org/10.1371/journal.pmed.1003434.s007, https://doi.org/10.1371/journal.pmed.1003434.s008, https://doi.org/10.1371/journal.pmed.1003434.s009, https://doi.org/10.1371/journal.pmed.1003434.s010, https://doi.org/10.1371/journal.pmed.1003434.s011, https://doi.org/10.1371/journal.pmed.1003434.s012, https://doi.org/10.1371/journal.pmed.1003434.s013, https://doi.org/10.1371/journal.pmed.1003434.s014, https://doi.org/10.1371/journal.pmed.1003434.s015, https://doi.org/10.1371/journal.pmed.1003434.s016. Search strategy: Project administration, Akturan and colleagues trained physicians on a therapeutic interviewing technique . Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan United States of America, Roles 2019 Mar 25;7(3):52. doi: 10.3390/medsci7030052. This revitalization of underlying care may make it difficult to detect modest differences attributable to education or support alone. Data on population characteristics, glycemic control outcomes, and study design were extracted. Difference in change-from-baseline HbA 1c values between behavioural interventions and usual care control…, Figure A3:. Further research is needed to assess non-glycemic outcomes and to study implementation in rural and low-income settings. Investigation, Sample sizes for cluster RCTs were adjusted to account for the design effect using the intracluster correlation coefficient (ICC) . Project administration, Ont Health Technol Assess Ser. We did not assess blood pressure outcomes given our primary interest in the evidence of interventions attempting to achieve glycemic control and prior meta-analyses supporting the effectiveness of health system interventions for blood pressure control [74,81]. Ramallo-Fariña Y, García-Bello MA, García-Pérez L, Boronat M, Wägner AM, Rodríguez-Rodríguez L, de Pablos-Velasco P, Llorente Gómez de Segura I, González-Pacheco H, Carmona Rodríguez M, Serrano-Aguilar P; INDICA Team. Differences in quality were mainly due to methodological issues such as inadequate description of randomization, sample size calculation allocation concealment, blinding and uncertainty of the use of intention-to-treat (ITT) analysis. Eight studies were at low risk of bias for the summary assessment of glycemic control, 15 studies were at unclear risk, and 16 studies were at high risk. DePue and colleagues conducted a cluster RCT in American Samoa that primarily used home visits and individual rather than group sessions . NIH Those are chlopropamide, glyburide, glipizide. Investigation, high-income countries; LMICs, In LMICs, published reviews of health system interventions for diabetes care have explored diabetes care models , integrated hypertension and diabetes care , and interventions with a lifestyle component . Appropriate management of lifestyle can effectively prevent the development of diabetes mellitus. Epub 2009 Oct 1. Type 2 diabetes is often associated with obesity. We found that health system interventions for type 2 diabetes may be effective in improving glycemic control in LMICs, but few studies were available from rural areas or low- or lower-middle-income countries. Most studies incorporated primary care doctors in a team-based intervention [30,31,59,60,62,63], and the study by Ali and colleagues incorporated endocrinologists . We thank the following authors of included studies for contributing supplementary information used in this review: María Cecilia Anzaldo-Campos, MD, MBA; Anna Chapman, PhD; Jeroen De Man; Shaun Wen Huey Lee, PhD; Aditya Khetan, MD; Professor Dr. Anis Safura Ramli; Professor Hong-Mei Wang, PhD; and Xuefeng Zhong, MD, MPH, PhD. Six of the studies primarily involved in-person delivery [32,40,43,46,49,56], and 3 studies delivered the intervention in group format [46,49,56]. Of the 283 articles excluded after full-text review, 103 articles were excluded due to the type of intervention, and 94 articles were excluded due to incomplete data. Multicomponent clinic-based interventions had the strongest evidence for glycemic benefit among intervention types. We included RCTs of health system interventions targeting non-pregnant, ambulatory adults with type 2 diabetes in LMICs. Standard lifestyle recommendations, metformin, and placebo are given to people who are at high risk for type 2 diabetes. 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