Further research is needed to assess non-glycemic … Medicine-Pediatrics Residency Program, University of Minnesota, Minneapolis, Minnesota, United States of America, Roles Writing – review & editing, Affiliations Two health system interventions involved physician clinical training alone [65,66]. 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? Face-to-face encounters were supplemented with telephone calls in 2 studies [32,54] and by computer-assisted instruction in another study . Of the 19 studies reporting mortality, 14 studies had 10 or fewer deaths combined in the intervention and comparator groups (S6 Appendix). The mean age of participants reported was approximately 58 years and the mean duration of diabetes was approximately 6 years. 2009;9(20):1-58. The overall between-arm HbA1c mean change was −0.46% (95% CI −0.60% to −0.31%, I2 87.8% [95% CI 84.0% to 90.6%]; Fig 2). Improving and scaling up care in LMICs is an urgent global health priority. 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. 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. Difference in change-from-baseline HbA 1c values between behavioural interventions and usual care control…, Figure A6:. Our findings imply a need for implementation research to investigate the details of health system interventions that confer durable improvements in clinical and patient-centered outcomes in LMICs, especially in rural areas and in low- and lower-middle-income countries. No, Is the Subject Area "Diabetes mellitus" applicable to this article? No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, https://doi.org/10.1371/journal.pmed.1003434, https://epoc.cochrane.org/sites/epoc.cochrane.org/files/public/uploads/taxonomy/epoc_taxonomy.pdf, https://epoc.cochrane.org/sites/epoc.cochrane.org/files/public/uploads/Resources-for-authors2017/suggested_risk_of_bias_criteria_for_epoc_reviews.pdf, http://epoc.cochrane.org/sites/epoc.cochrane.org/files/public/uploads/Resources-for-authors2017/summary_assessments_of_the_risk_of_bias.pdf, http://epoc.cochrane.org/resources/epoc-resources-review-authors. The search dates were from database inception through February 24, 2020. Ont Health Technol Assess Ser. Reviews of articles published before 2000 show the potential benefits of self‐management interventions but provide inconsistent results for various outcome measures. Two studies involved nursing case management interventions. Three studies were based on the Chronic Care Model [60,62,63]. Writing – original draft, Project administration, Prespecified subgroup analyses were done by intervention type. Agency for Healthcare Research and Quality (US). Both the intervention and comparator arm in this trial had out-of-pocket medical fees waived, which may have contributed to catalyzing participants to seek medical care. 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]. Finally, although there were substantial similarities within intervention types, individual studies varied by setting and population, limiting our ability to make conclusions with high degrees of certainty. 2. This aspect reflects a limitation of the evidence generated rather than one of the analysis itself. Multicomponent clinic-based interventions had the strongest evidence for glycemic benefit among intervention types. | Methodology, Prior reviews of task shifting for chronic diseases in LMICs have identified few trials in type 2 diabetes [72,73]. Of note, the comparator arm in 2 of these well-conducted multicomponent clinic-based trials consisted of enhanced usual care [30,31], potentially causing an attenuation of effect size. Formal analysis, Epub 2009 Oct 1. If outcomes were missing or not reported, we contacted authors twice to obtain data. We extracted study elements including the 4 outcomes, country, setting, duration and follow-up, number of participants enrolled, intervention description, and comparator. Methodology, The Fundamentals of Nursing Care Plan for Type 2 Diabetes – The Checklist. After removing 1,093 duplicates, we screened 11,828 references by title and abstract and assessed 322 full-text articles for eligibility. Further research is needed to assess non-glycemic outcomes and to study implementation in rural and low-income settings. Distinct from task shifting, task sharing emphasizes the shared responsibility for a task between the health workers’ different levels and types of training . Abstracts were reviewed by a single author and studies meeting the inclusion criteria outlined above were obtained. Outcomes of mortality, health-related quality of life, and cost-effectiveness were reported in 19, 11, and 5 studies, respectively. randomized controlled trial; SMS, 11th Feb 2020 Nursing Literature Review Reference this Tags: health. Much of this cost arises from the serious long-term complications associated with the disease including: coronary heart disease, stroke, adult blindness, limb amputations and kidney disease. The prediction interval is depicted as the horizontal whiskers intersecting the overall effect diamond marker. We defined LMICs using the 2019 World Bank income groups. • The primary outcome involved change in HbA1c or the proportion of participants meeting HbA1c goals in 23 studies. Reutens and colleagues trained physicians in multiple countries on diabetes guidelines using 2 in-person sessions and reminders . At the same time, the wide prediction interval overlapping 0 in the meta-analysis of HbA1c showed that there was a wide range of effectiveness across studies, and some health system interventions may not be effective in all settings. We excluded non-randomized study designs given the challenge in attributing causality for outcomes and inconsistent reporting of these designs in pilot searches. August 2017 The certainty of evidence using the GRADE/EPOC approach for glycemic control by subgroup was moderate for multicomponent clinic-based interventions but was low or very low for other intervention types (S15 Appendix). The quality of the studies ranged from moderate to low with four of the studies being of moderate quality and the remaining seven of low quality (based on the Consort Checklist). The search strategy was built in English, and no language filters were applied. At the same time, multiple well-conducted trials had null results [30,31,62]. We investigated the experience of individuals diagnosed with type 2 diabetes mellitus (T2DM) who participated in an intervention in which the key elements were the provision of a smartphone and self-monitoring software. 2017. Reference lists were also checked for relevant studies. Our search strategy identified 12,921 references (Fig 1). All studies evaluated type 2 diabetes patients exclusively. Health Sciences Libraries, University of Minnesota, Minneapolis, Minnesota, United States of America, Roles The search identified 638 citations published between 1996 and August 2008, of which 12 met the inclusion criteria and one was a meta-analysis (Gary et al. The study setting was primarily urban in 27 trials and primarily rural in 5 trials. ". • It is unclear how to identify people at high risk of type 2 diabetes by virtue of having a relative and/or partner with diabetes. high-income countries; LMICs, Two studies described the comparator group as enhanced usual care, where the enhancement consisted of clinical training for health professionals [30,31], and in 1 study the medical fees were waived in the comparator arm . Conceptualization, 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. Interventions for Type 2 Diabetes Literature Review. Practical telehealth to improve control and engagement for patients with clinic-refractory diabetes mellitus (PRACTICE-DM): Protocol and baseline data for a randomized trial. Studies with a control group other than usual care Studies with a sample size <30 Studies without a clearly defined intervention, Primary outcome: Criteria for self-management support intervention, Figure A1:.
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