Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg Faculty of Medicine, Halle, Germany
Department of Haematology and Oncology, University of Göttingen, Gottingen, Germany.
BMJ Open. 2022 May 11;12(5):e050021. doi: 10.1136/bmjopen-2021-050021.
The epidemiological transition from infectious to chronic diseases leads to novel challenges in African health systems. The prevalence of diabetes mellitus (DM) is increasing dramatically. Undiagnosed and undertreated DM leads to numerous complications including end-organ damage and death. Our objectives were to collect the best locally generated evidence on DM interventions, identify knowledge gaps and determine underexplored research areas.
A systematic review and meta-analysis of randomised controlled trials.
African patients in primary, secondary and tertiary prevention, diagnosis and treatment DM type 1 (DM1), type 2 (DM2) and gestational DM (GDM).
All-cause mortality, glycaemic control, complications, quality of life, hospital admission, treatment adherence and costs.
Articles published in MEDLINE Ovid, CENTRAL, CINAHL, African Journals Online and African Index Medicus and the International Clinical Trials Registry Platform in English language without time restrictions. The systematic search was last updated in October 2020.
Out of 3736 identified publications, we included 60 eligible studies conducted in 15 countries, 75% were conducted in urban healthcare settings, including 10 112 participants. We included 8 studies on DM1, 6 on GDM, 2 on pre-DM, 37 on mainly DM2 including 7 on DM-related complications. The design of the studied intervention was heterogeneous with a focus on educational strategies. The other studies investigated the efficacy of nutritional strategies including food supplementations, pharmacological strategies and strategies to enhance physical activity. Seven studies included interventions on DM-related complications.
Research activities increased in recent years, but available evidence is still not representative for all African countries. There is a big lack of evidence in primary healthcare and rural settings, implementation research, pharmacological interventions, especially in poorer countries. Nevertheless, the identified studies offer a variety of effective interventions that can inform medical care and future research.
CRD42019122785.
从传染病到慢性病的流行病学转变给非洲卫生系统带来了新的挑战。糖尿病（DM）的患病率正在急剧上升。未确诊和治疗不足的 DM 会导致许多并发症，包括终末器官损害和死亡。我们的目标是收集关于 DM 干预措施的最佳本地生成证据，确定知识空白，并确定探索不足的研究领域。
随机对照试验的系统评价和荟萃分析。
在初级、二级和三级预防、诊断和治疗 1 型糖尿病（DM1）、2 型糖尿病（DM2）和妊娠期糖尿病（GDM）的非洲患者。
全因死亡率、血糖控制、并发症、生活质量、住院、治疗依从性和成本。
在 MEDLINE Ovid、CENTRAL、CINAHL、African Journals Online 和 African Index Medicus 以及国际临床试验注册平台上以英文发表的文章，无时间限制。系统搜索最后一次更新时间为 2020 年 10 月。
在 3736 篇已确定的出版物中，我们纳入了 60 项符合条件的研究，这些研究在 15 个国家进行，其中 75%是在城市医疗保健环境中进行的，包括 10112 名参与者。我们纳入了 8 项关于 DM1 的研究、6 项关于 GDM 的研究、2 项关于前 DM 的研究、37 项主要关于 DM2 的研究，其中 7 项关于与 DM 相关的并发症。所研究干预措施的设计具有异质性，重点是教育策略。其他研究调查了营养策略的疗效，包括食物补充、药理学策略和增强身体活动的策略。有 7 项研究包括与 DM 相关的并发症干预措施。
近年来研究活动有所增加，但现有证据仍不能代表所有非洲国家。初级保健和农村地区、实施研究、药理学干预措施，特别是在较贫穷国家，缺乏大量证据。然而，所确定的研究提供了多种有效的干预措施，可以为医疗保健和未来的研究提供信息。
PROSPERO 注册号：CRD42019122785。
