Effectiveness and safety of self-management interventions for improving glycemic control and health-related quality-of-life among adults with type 2 diabetes mellitus in sub-Saharan Africa: a systematic review and meta-analysis.

OBJECTIVE: The objective of this review was to assess and synthesize evidence on the effectiveness and safety of self-management interventions for improving glycemic control and health-related quality of life (HRQoL) among adults with type 2 diabetes mellitus (T2DM) in sub-Saharan Africa. INTRODUCTION: There has been a rapid increase in the prevalence of T2DM in sub-Saharan Africa. Lifestyle-related risk factors require self-management strategies, and these must be tailored to the context. Several randomized controlled trials (RCTs) evaluating T2DM self-management interventions in sub-Saharan Africa have been conducted. INCLUSION CRITERIA: This systematic review included RCTs assessing the effectiveness and safety of self-management interventions among adults with T2DM in sub-Saharan Africa, where the self-management intervention matched at least 1 category of the Practical Reviews in Self-Management Support (PRISMS) for long-term conditions taxonomy. METHODS: The following databases were searched from inception until January 14, 2023: MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), PsycINFO (Ovid), Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Directory of Open Access Journals, EthOS, and ProQuest Dissertations and Theses (ProQuest). Global Health (EBSCOhost) was searched from inception until June 8, 2021. OpenGrey was searched from inception until its archive date of December 1, 2020. Two independent reviewers conducted title and abstract screening, full-text screening, data extraction, and critical appraisal. Disagreements were resolved through discussion or with a third reviewer. Data synthesis was conducted narratively, followed by meta-analysis where feasible. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach for assessing the certainty of evidence was applied. RESULTS: From 2699 records identified, 18 RCTs were included in the systematic review and 14 in the meta-analysis. Interventions included broad self-management education programs, peer support, exercise interventions with education, nutrition education, educational text messaging, and blood glucose self-monitoring support. Only 4 studies were assigned a "yes" result for more than half of the criteria in the standardized JBI critical appraisal tool for RCTs. Compared to the control, self-management interventions did not significantly reduce glycated hemoglobin (HbA1c) at 3 months (302 participants, mean difference [MD] -6.0 mmol/mol, 95% CI -17.5, 5.4; very low certainty on GRADE assessment) or 12 months (1504 participants, MD -3.7 mmol/mol, 95% CI -8.2, 0.7; moderate certainty on GRADE assessment). HbA1c was significantly reduced at 6 months (671 participants, MD -8.1 mmol/mol, 95% CI -10.7, -5.4; low certainty on GRADE assessment). Four studies assessed HRQoL, but only 1 demonstrated an improvement (2205 participants). Three studies reported no adverse events in relation to the trial interventions (1217 participants), and it was not reported in the remainder. There did not appear to be clinically significant effects on body mass index, lipid profile, and systolic or diastolic blood pressure. The evidence was mixed for weight and waist circumference. CONCLUSIONS: Self-management interventions for adults living with T2DM in sub-Saharan Africa may produce a clinically significant improvement in glycemic control at 6 months, but this may wane in the longer-term. There was not convincing evidence to indicate a benefit of these interventions on HRQoL, but reporting on this outcome measure was limited. There were insufficient data on adverse events to be able to draw conclusions. REVIEW REGISTRATION: PROSPERO CRD42021237506.

Lifestyle behaviours and associated factors among people with type 2 diabetes attending a diabetes clinic in Ningbo, China: A cross-sectional study.

The burden of type 2 diabetes (T2DM) in China is significant and growing, and this is reflected in high rates of T2DM in the city of Ningbo, China. Consequent impacts on morbidity, mortality, healthcare expenditure, and health-related quality of life, make this a problem of the utmost importance to address. One way to improve T2DM outcomes is to address lifestyle behaviours that may affect prognosis and complications, such as physical activity levels, dietary habits, smoking status, and alcohol intake. A cross-sectional survey was undertaken to describe the prevalence of being physically active, having a healthy diet, currently smoking, and currently drinking alcohol among people living with T2DM attending a diabetes clinic in Ningbo, China. Regression analysis was used to determine the factors associated with these lifestyle behaviours. We found a high prevalence of a healthy diet (97.8%, 95% CI 96.5-98.7%). Prevalence of being physically active (83.4%, 95% CI 80.6-85.9%), smoking (21.6%, 95% CI 18.8-24.6%), and alcohol drinking (32.9%. 95% CI 29.6-36.2%) appeared in keeping with those of the general population. Marked associations were demonstrated between male sex and smoking (OR 41.1, 95% CI 16.2-139.0), and male sex and alcohol drinking (OR 4.00, 95% CI 2.62-6.20). Correlation between lifestyle factors was demonstrated including between alcohol drinking and smoking, and between physical activity and reduced smoking. General diabetes self-management education programmes that address multiple lifestyle risk factors simultaneously may be beneficial in this population. Specific interventions targeting smoking cessation and reduction in alcohol drinking may be of benefit to men living with T2DM attending a diabetes clinic in Ningbo.

Understanding the fundamental elements of global health: Using the sen capability approach as the theoretical framework for a health needs assessment in deprived communities.

Background: The health needs in poor communities are often dictated by data that is not relevant to the community. The capabilities approach (CA) offers a philosophical and practical way to frame and analyse data and apply it to a community using the World Health Organisation socioeconomic framework. This was part of the NHS Health Education England East Midlands Global Health Exchange Fellow Programme. Methods: A team of 2 Kenyan and 2 UK community clinicians worked together in deprived communities in Kenya and the UK using qualitative research methods to facilitate the communities to define and prioritise their health needs and to explore their potential resources and how they might achieve their needs sustainably. The CA was used in the data collection and data analysis phases. Results: The team of fellows gained personal understanding of the reality of the impact of social determinants on health experiences and outcomes. The CA offers the health systems and services a way to engage hard to reach communities with issues that they know to be important and are then able to prioritise. Clinicians who are taught in the evidence based style need to reframe their understanding of community needs if they are to be effective in their work. Working in this way can challenge their own values and beliefs. With planned support this can be a powerful developmental process and the CA is a set of principles that can be used to facilitate the empowerment of communities, the service planners and providers.

Evaluation of a multiprofessional learning organisation: use of a questionnaire to investigate the learning experiences of a group of undergraduate pharmacy students attached to primary care.

PURPOSE OF THE RESEARCH: This paper reports on the evaluation of the educational benefits to third-year MPharm students attached to four Nottingham inner-city training practices as part of the first cohort of learners to come to a multiprofessional learning organisation (MPLO). The aim was to identify areas of benefit above and beyond those available at their core course in order to identify areas for further study. METHODOLOGY: This study used a mixture of both quantitative and qualitative methods to generate ideas through grounded theory. It used a hermeneutic approach to define multiprofessional learning and professional roles. METHODS: A questionnaire was developed and all students were invited to complete it at the end of their attachments. It was analysed using an SPSS computer package. FINDINGS: The main benefits perceived by pharmacy students were concerning development of professional role, behaviour in the field (legitimate peripheral participation) and emergence of professional identity. From the findings the authors have described an MPLO as 'an educational enterprise between different professions which has an ethos of mutual co-operation and understanding of each other's roles, emphasises communication and idea sharing and exists within a environment of 'smooth systems functioning". • An MPLO can be defined as: 'an educational enterprise between different professions which has an ethos of mutual co-operation and understanding of each other's roles, emphasises communication and idea sharing, and exists within a environment of 'smooth systems functioning'. • Neophyte professionals want to practise interprofessional behaviour. • Professional identity is enhanced when group differences are emphasised and the move to homogenise professional groups through interprofessional working may not be successful. • Educators must help learners challenge professional stereotypes and enable them to develop flexibility to meet future challenges.

Discovering the research priorities of people with diabetes in a multicultural community: a focus group study.

BACKGROUND: Usually experts decide on which research is worthwhile, yet it is government policy to involve service users in research. There has been a lack of published research about involving patients from minority ethnic groups and people from deprived areas in setting research agendas. In this study we wanted to hear the voices of patients that are not often heard. AIM: To find out the research priorities of people with diabetes from an inner city community and compare these with current expert-led research priorities in diabetes. DESIGN OF STUDY: A qualitative study using a participatory approach with consumer groups. SETTING: Primary care within inner city Nottingham, UK. METHOD: Thirty-nine adult patients with diabetes with varying ethnic backgrounds recruited from three general practices. Six focus groups carried out in participants' preferred language, analysed using the constant comparative method. RESULTS: Nine main themes equating to research priorities were identified. Within these themes, information and awareness, service delivery and primary prevention of diabetes emerged as the main factors. There were no science-based topics and there was more emphasis on culturally influenced research questions, which differed from recent Department of Health priorities. There were several themes about service delivery, patient self-management and screening and prevention of diabetes that overlapped. CONCLUSIONS: There is some divergence between expert-led and patient-led agendas in research about diabetes. Patient perspectives have a significant influence on research priorities, and there are likely to be several different patient perspectives.