Effectiveness of diabetes self-management education interventions on glycemic control in persons with diabetes in Africa: a systematic review and meta-analysis.

BACKGROUND

Achieving effective glycemic control remains a major challenge in Africa, with over 50% of individuals with diabetes not meeting recommended targets. This systematic review aimed to evaluate the effectiveness of diabetes self-management education (DSME) interventions on glycemic control (HbA1c) in persons with diabetes in Africa.

METHODS

Studies were retrieved from searches conducted on PubMed, CINAHL, Scopus, Web of Science, and Cochrane Library, from their inception to 9 June 2024. The search strategy included keywords and database-specific indexed terms such as (i) diabetes, (ii) diabetes self-management education, (iii) glycemic control, and (iv) Africa. The DerSimonian-Laird random effect model was used to pool the mean difference in HbA1c levels. Heterogeneity across studies was assessed using the statistic, and subgroup analyses were conducted to explore sources of variability.

RESULTS

Seventeen randomized controlled trials involving 3730 participants met the inclusion criteria. Most DSME interventions were delivered in person, with only two studies utilizing mobile health (mHealth) approaches. The meta-analysis showed a significant reduction in HbA1c levels in the DSME intervention compared to usual care, with a pooled mean difference of -1.02% (95% CI -1.46 to -0.58). Subgroup analyses revealed variations in effectiveness based on intervention characteristics; however, these were not statistically significant.

CONCLUSION

DSME interventions significantly improve glycemic control compared to usual care among people with diabetes in Africa. Future research should investigate context-specific factors that may influence the effectiveness of these interventions.