| Background Diabetes Mellitus is a metabolic disorder that results from defects in insulin secretion in combination with insulin resistance and is characterized by abnormally increased blood glucose levels.Its prevalence is significantly increasing at a global level with estimated171 million people being currently affected.These numbers are predicted to increase to366 million by 2030.The global burden of diabetes is increasing with the prevalence of diabetes for all age groups worldwide.On a global scale,diabetes is estimated to be the fifth leading cause of death with the burden of Type 2 diabetes(T2D)being unevenly distributed across the population.Ethnic minority groups have higher prevalence and incidence rates of type 2 diabetes and also higher rates of diabetes complications.Minorities and immigrants in the U.K from India,South Africa,Fiji,Trinidad and Singapore,South east Asians in the UK,Hipanic and Native Americans in the US consistently show higher prevalence rates of Type 2 diabetes than the local populations.The reasons for this could be cultural issues such as language,beliefs,certain risk factor behaviours,dietary and medical treatment preferences.It is necessary to allocate and evaluate culturally tailored interventions in the public health system in order to address these health disparities.Culturally appropriate interventions that are catered to ethnic minority groups and socially disadvantaged populations can be effective,thereby having a great potential to reduce health disparities in diabetes care and outcomes.The main aims of the study are to increase the current growing knowledge of the effects of culturally appropriate diabetes intervention,which can that lead to successful outcomes and to suggest directions for future research.MethodsWe undertook a systematic literature review and meta-analysis following the PRISMA guideline.Appropriate studies of culturally appropriate intervention for Type 2 diabetes in ethnic minorities were identified through searches of electronic databases including Web of Science,the Cochrane Library,Pub Med and Scopus(from inception to January 2021).We included all studies examining the efficacy of culturally adapted health interventions targeted to racial/ethnic minority adults with type 2 diabetes.Quality of the included studies was evaluated using the second version of the Cochrane Collaboration’s tool for assessing risk of bias(Ro B 2)for randomised controlled trials and the methodological index for nonrandomized studies(MINORS)for the non-randomised trials.Structured forms were used to extract information on study characteristics,intervention characteristics and effectiveness.Data on the intervention characteristics was analysed using qualitative approach to derive common themes,and intervention efficacy was assessed through metaanalysis of eligible studies.ResultsThirty-five studies were identified for inclusion in the systematic review,of which twentyfive were included in a meta-analysis.Majority of the studies were located in the US,and the main ethnic minority groups were Latinx/Hispanic and African Americans.There was a wide range on intervention and education types as well as the types of intervention providers.Meta-analysis was performed on the physiological outcomes,and the results demonstrated statistically significant benefits in favour of the culturally adapted interventions.The culturally appropriate interventions produced a reduction in glycated haemoglobin(Hb A1c)of-0.40%(95% CI-0.60% to-0.19%;P<0.001),a reduction in BMI of-0.89(95% CI-1.36 to-0.42;p<0.001),a reduction in total cholesterol of-5.89(95% CI-9.73 to-2.05;P<0.001).The effect of culturally adapted interventions on other outcomes in terms of weight(standardized mean difference-0.56,95% CI-2.06 to 0.94;P=0.46),LDL(standardized mean difference-5.19,95% CI-11.13 to 0.74;P=0.09),SBP(standardized mean difference-0.74,95% CI-2.36 to 0.87;P=0.37)and DBP(standardized mean difference-0.11;95% CI-1.21 to 1.43;P=0.87)were yet not significant.ConclusionsThis meta-analysis provides evidence that culturally appropriate interventions can have an overall positive effect on some of the physiological outcomes among adults with Type 2diabetes from ethnic minority groups.The review focused on the overall effect of the cultural interventions,but it does not look at the particular interventions,health care providers or specific ethnic groups.Further research is warranted to examine and identify the aspects of the culturally appropriate interventions that are more effective in targeted ethnic groups.Findings from the current study support the continued development and evaluation of culturally adapted health interventions on T2 D among ethnic minority groups,and suggest that future policy initiatives should take the inter-ethnic differences into account. |
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