Leonard E. Egede (
Rebekah J. Walker, Medical College of Wisconsin.
Health Aff (Millwood). 2022 Jul;41(7):963-970. doi: 10.1377/hlthaff.2022.00236. Epub 2022 Jun 27.
This systematic review identified studies of nonmedical interventions designed to reduce risk for and improve clinical outcomes for type 2 diabetes. Specifically, this review sought to identify interventions that target structural racism and social determinants of health. To be included, studies were published in English; published between database initiation and January 2022; conducted in the United States; measured an intervention effect using a clinical trial, quasi-experimental, or pre-post design; included a population of adults at risk for or with type 2 diabetes; and targeted hemoglobin A1c levels, blood pressure, lipids, self-care, or quality of life as outcomes. The findings of our review indicate that interventions with targeted, multicomponent designs that combine both medical and nonmedical approaches can reduce risk for and improve clinical outcomes for type 2 diabetes. HbA1c levels improved significantly with the use of food supplementation with referral and diabetes support; the use of financial incentives with education and skills training; the use of housing relocation with counseling support; and the integration of nonmedical interventions into medical care using the electronic medical record. Our findings demonstrate that the literature on nonmedical interventions designed to address relevant social factors and target structural racism is limited. The article offers actionable strategies and identifies policy opportunities for targeting structural inequalities and decreasing social risk among adults with type 2 diabetes.
这篇系统评价确定了旨在降低 2 型糖尿病风险和改善临床结局的非医学干预措施的研究。具体而言，本综述旨在确定针对结构性种族主义和健康社会决定因素的干预措施。纳入标准为：以英文发表；发表于数据库启动和 2022 年 1 月之间；在美国进行；使用临床试验、准实验或前后设计测量干预效果；纳入有 2 型糖尿病风险或患有 2 型糖尿病的成年人；并以糖化血红蛋白水平、血压、血脂、自我护理或生活质量作为结局。我们的综述结果表明，具有针对性、多组分设计的干预措施，结合医学和非医学方法，可以降低 2 型糖尿病的风险并改善临床结局。使用食物补充并转诊和提供糖尿病支持、使用教育和技能培训结合经济奖励、使用咨询支持结合住房搬迁、以及通过电子病历将非医学干预措施整合到医疗保健中，均可显著改善糖化血红蛋白水平。我们的研究结果表明，旨在解决相关社会因素和针对结构性种族主义的非医学干预措施的文献有限。本文提供了切实可行的策略，并确定了针对结构性不平等和降低 2 型糖尿病成年人社会风险的政策机会。
