The effect of diabetes self-management education on HbA1c and quality of life in African-Americans: a systematic review and meta-analysis

Abstract

Abstract Background Type 2 diabetes presents a major morbidity and mortality burden in the United States. Diabetes self-management education (DSME) is an intervention associated with improved hemoglobin A1c(HbA1c) and quality of life(QOL), and is recommended for all individuals with type 2 diabetes. African-Americans have disproportionate type 2 diabetes morbidity and mortality, yet no prior meta-analyses have examined DSME outcomes exclusively in this population. This systematic review and meta-analysis examined the impact of DSME on HbA1c and QOL in African-Americans compared to usual care. Methods Randomized controlled trials, cluster-randomized trials, and quasi-experimental interventions were included. 352 citations were retrieved; 279 abstracts were reviewed, and 44 full-text articles were reviewed. Fourteen studies were eligible for systematic review and 8 for HbA1c meta-analysis; QOL measures were too heterogeneous to pool. Heterogeneity of HbA1c findings was assessed with Cochran’s Q and I 2. Results HbA1c weighted mean difference between intervention and usual care participants was not significant: − 0.08%[− 0.40–0.23];χ 2 = 84.79 (p < .001), I 2 = 92%, (n = 1630). Four of five studies measuring QOL reported significant improvements for intervention participants. Conclusions Meta-analysis results showed non-significant effect of DSME on HbA1c in African-Americans. QOL did show improvement and is an important DSME outcome to measure in future trials. Further research is needed to understand effectiveness of DSME on HbA1c in this population. Trial registration PROSPERO registration: CRD42017057282.

Keywords

• Type 2 diabetes
• Diabetes self-management education
• African-Americans
• Disparities