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Systematic Review of the Impact of Race/Ethnicity or Type of Health Professional | |||||||||||||||||||||||||||||||||||||||||||||||
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| Project Description Objective: The objective of this study was to review the success of delivering interventions aimed at modifying lifestyle behaviors in patients with type 2 diabetes as measured by reduction in glycosylated hemoglobin (HbA1c), which is a marker of long-term glycemic control. The literature was reviewed and compared by focus of lifestyle intervention regarding the relative success in reducing HbA1c, by health care professional (HCP) and by race/ethnicity of the patient population. Methods: We performed a systematic review of the literature to identify articles through July 2007 using the medical databases: MEDLINE, CINAHL, PsychINFO, and IPA. Our terms specified glycosylated hemoglobin, diabetes mellitus, type 2; type 2 diabetes; type 2 diabetics; non-insulin dependent diabetes mellitus; education; health education; lifestyle; intervention; control; glucose; glycemic; HbA1c; structured diabetes care; outcome; outcome assessment; and outcome and process assessment. We reviewed the article titles and abstracts to determine relevance for inclusion in the health professional review and/or the race/ethnicity review. After assessing each relevant article for quality, we summarized them into tables and formulated conclusions. Results: There were 1,053 articles examined from our search criteria. After applying our selection criteria, 23 articles specified the impact of lifestyle interventions among specific races or ethnicities and 45 articles specified outcomes by types of health professionals. Among HCPs, there were no differences between involvement of more than one type of HCP versus a single HCP (pharmacists, nurses, and dieticians) and no differences between HCPs. Regarding race/ethnicity articles, only one article compared the effectiveness of interventions by race/ethnicity. More commonly, only specific races were included in the studies. Interventions that were culturally designed were primarily used. Conclusion: The literature regarding lifestyle interventions to improve diabetes control is rich. However, often interventions are aimed at patients who are in very poor diabetes control. Thus, results are not generalizable to patients who are moderately well-controlled and in whom the benefit may be more incremental but still clinically important. Although ethnic-relevance is recognized as an important factor in providing diabetes lifestyle interventions, few studies have demonstrated a differential effect by ethnicity and no studies have compared ethnically relevant versus other types of interventions. Eligibility | |||||||||||||||||||||||||||||||||||||||||||||||
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