A Systematic Review of Interventions to Improve Diabetes Care in Socially Disadvantaged Populations

  1. Richard H. Glazier, MD1234,
  2. Jana Bajcar, EDD25,
  3. Natalie R. Kennie, PHARMD25 and
  4. Kristie Willson, MHSC4
  1. 1Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, Ontario, Canada
  2. 2Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
  3. 3Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
  5. 5Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
  1. Address correspondence and reprint requests to Richard H. Glazier, Centre for Research on Inner City Health, St. Michael’s Hospital, 30 Bond St., Toronto, Ontario, Canada. E-mail: richard.glazier{at}utoronto.ca

Abstract

OBJECTIVE—To identify and synthesize evidence about the effectiveness of patient, provider, and health system interventions to improve diabetes care among socially disadvantaged populations.

RESEARCH DESIGN AND METHODS—Studies that were included targeted interventions toward socially disadvantaged adults with type 1 or type 2 diabetes; were conducted in industrialized countries; were measured outcomes of self-management, provider management, or clinical outcomes; and were randomized controlled trials, controlled trials, or before-and-after studies with a contemporaneous control group. Seven databases were searched for articles published in any language between January 1986 and December 2004. Twenty-six intervention features were identified and analyzed in terms of their association with successful or unsuccessful interventions.

RESULTS—Eleven of 17 studies that met inclusion criteria had positive results. Features that appeared to have the most consistent positive effects included cultural tailoring of the intervention, community educators or lay people leading the intervention, one-on-one interventions with individualized assessment and reassessment, incorporating treatment algorithms, focusing on behavior-related tasks, providing feedback, and high-intensity interventions (>10 contact times) delivered over a long duration (≥6 months). Interventions that were consistently associated with the largest negative outcomes included those that used mainly didactic teaching or that focused only on diabetes knowledge.

CONCLUSIONS—This systematic review provides evidence for the effectiveness of interventions to improve diabetes care among socially disadvantaged populations and identifies key intervention features that may predict success. These types of interventions would require additional resources for needs assessment, leader training, community and family outreach, and follow-up.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    DOI: 10.2337/dc05-1942

    • Accepted March 19, 2006.
    • Received October 11, 2005.
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